Individual provider Active NPI

Rom A Stevens, M.D.

  • Critical Care Medicine (Internal Medicine) Physician
  • Cudahy, WI
National Provider Identifier
1073596730
Registry record updated Oct 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine (Internal Medicine) PhysicianTaxonomy code 207RC0200X
License
25448 Issued in WI
Practice address
5900 S Lake Dr
Cudahy, WI 53110-3171
Phone
(414) 489-9000
NPI assigned
Nov 26, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Pain Medicine Physician 208VP0014X 25448-020 WI
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 25448 WI Primary

Addresses

Primary practice location

5900 S Lake Dr
Cudahy, WI 53110-3171

Mailing address

PO Box 735044
Chicago, IL 60673-5044
Phone (414) 489-9000

Other practice location 1

2901 W Kinnickinnic River Pkwy Ste 315
Milwaukee, WI 53215-3660
Phone (414) 649-5646

Other identifiers 1

IdentifierTypeStateIssuer
31779900MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
25448-020WIMDInterventional Pain Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Comprehensive Cardiovascular Care, LLP Past Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1132963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696896000000",
    "number": "1073596730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 735044",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606735044",
            "telephone_number": "414-489-9000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5900 S LAKE DR",
            "city": "CUDAHY",
            "state": "WI",
            "postal_code": "531103171",
            "telephone_number": "414-489-9000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2901 W Kinnickinnic River Pkwy Ste 315",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532153660",
            "country_code": "US",
            "telephone_number": "414-649-5646",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STEVENS",
        "first_name": "ROM",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-26",
        "last_updated": "2023-10-10",
        "certification_date": "2023-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "WI",
            "license": "25448-020",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "WI",
            "license": "25448",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31779900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cudahy, WI

Sources for this page

Verify at the official NPI Registry.