Mind Neurology Wisconsin SC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

Legal business name

MIND NEUROLOGY WISCONSIN SC

Practice address

12200 Corporate Pkwy Ste 400
Mequon, WI 53092-3300

Phone

(414) 430-0069

NPI assigned

Jun 6, 2022

Last updated

Aug 19, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jacob Hart, RN BSN MBA

Title

Chief Operating Officer

Phone

(414) 430-0069

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/26712/brand/1/csg/1/fhir/r4

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Aaron H Bubolz, D.O.

  • Neurology Physician
  • Green Bay, WI
  • NPI 1831486828
  Medicare reassignment NPD
• Kari Lynn Hart, OTR

  • Skilled Nursing Facility
  • Waukesha, WI
  • NPI 1811261472
  Medicare reassignment NPD
• Gable K Holderness, FNP-C

  • Nurse Practitioner
  • Green Bay, WI
  • NPI 1851709810
  Medicare reassignment NPD
• Jensen Pearson, DPT

  • Physical Therapist
  • Oshkosh, WI
  • NPI 1245924638
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1654473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724025600000",
    "number": "1073242194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12200 CORPORATE PKWY STE 400",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530923300",
            "telephone_number": "888-585-7975",
            "fax_number": "833-687-1434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12200 CORPORATE PKWY STE 400",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530923300",
            "telephone_number": "414-430-0069"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1725 N Casaloma Dr",
            "address_purpose": "LOCATION",
            "city": "Appleton",
            "state": "WI",
            "postal_code": "549137916",
            "country_code": "US",
            "telephone_number": "888-585-7975",
            "fax_number": "833-687-1434",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MIND NEUROLOGY WISCONSIN SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-06",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-19",
        "status": "A",
        "authorized_official_last_name": "HART",
        "authorized_official_first_name": "JACOB",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "414-430-0069",
        "authorized_official_credential": "RN BSN MBA"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Milwaukee Hand Center S C (The Milwaukee Hand Center)
• Milwaukee Hearing Center LLC
• Milwaukee Orthopaedic Group LTD
• Milwaukee Recovery Associates LLC
• Mind Matters Psychological Services, S.C.
• Mindful Rejuvenation Mental Health Counseling LLC
• Paul Minor, MD
• Carley Skye Mitz, PHARMD
• Rachel Mix
• Mitchell Edward Mleziva

• Medical Specialty Clinic/Center in Mequon, WI
• Providers in Mequon, WI by specialty
• Medical Specialty Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.