NPIMap

Organization Active NPI

Arc of Life Medical Center LLC

Doing business as Arc of Life Medical Center

  • Anesthesiology Physician
  • Madison, WI
National Provider Identifier
1073711503
Registry record updated Oct 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
ARC OF LIFE MEDICAL CENTER LLC
Doing business as
Arc of Life Medical Center
Practice address
648 S Gammon Rd
Madison, WI 53719-1370
Phone
(608) 441-3455
NPI assigned
Jul 5, 2007
Last updated
Oct 15, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2023

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

Authorized official

Name
Dr. Kaili Ann Richey, D.C.NPI 1841381936
Title
Manager / Partial Owner
Phone
(608) 441-3455

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X Primary

Addresses

Primary practice location

648 S Gammon Rd
Madison, WI 53719-1370

Mailing address

648 S Gammon Rd
Madison, WI 53719-1370
Phone (608) 441-3455

Other identifiers 1

IdentifierTypeStateIssuer
38734300MedicaidWI

Other names 1

  • Arc of Life Medical Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20071015000118 WI Part B Supplier - Clinic/Group Practice 6406942994 Receives reassigned benefits from 4 practitioners
Practice locations: Madison, WI
O20220718001796 WI DME Supplier - Multi-Specialty - Physician 6406942994 Practice locations: Madison, WI

National Provider Directory

National Provider Directory

Locations

293 Independence Blvd
Ste 330
Virginia Beach, VA 23462
Phone (757) 222-3100

648 S Gammon Rd
Madison, WI 53719
Phone (608) 441-3455

Practitioners & affiliated clinicians

Practitioners 19

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.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1183593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697328000000",
    "number": "1073711503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "648 S GAMMON RD",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537191370",
            "telephone_number": "608-441-3455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "648 S GAMMON RD",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537191370",
            "telephone_number": "608-441-3455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARC OF LIFE MEDICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-05",
        "last_updated": "2023-10-15",
        "certification_date": "2023-10-13",
        "status": "A",
        "authorized_official_last_name": "RICHEY",
        "authorized_official_first_name": "KAILI",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "MANAGER / PARTIAL OWNER",
        "authorized_official_telephone_number": "608-441-3455",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38734300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Arc of Life Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Madison, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.