NPIMap

Individual provider Active NPI

Benny Kusuma, MD

  • Internal Medicine Physician
  • La Crosse, WI
National Provider Identifier
1073734133
Registry record updated Feb 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
52325 Issued in WI
Practice address
1836 South Ave
La Crosse, WI 54601-5429
Phone
(608) 782-7300
NPI assigned
May 2, 2007
Last updated
Feb 8, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 6295 KS
Internal Medicine Physician 207R00000X 52325 WI Primary

Addresses

Primary practice location

1836 South Ave
La Crosse, WI 54601-5429

Mailing address

1836 South Ave
La Crosse, WI 54601-5429
Phone (608) 782-7300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, IA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20090610000023 WI Practitioner - Internal Medicine 5698825883 Reassigns benefits to 8 organizations
I20170213001525 IA Practitioner - Internal Medicine 5698825883 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Josephs Health Services IncGroup PAC ID 3971586439, 71 clinicians

Practice addresses (Care Compare)

1836 S Ave
La Crosse, WI 54601-5429
Phone (608) 783-7300

1910 S Ave
La Crosse, WI 54601-5467
Phone (608) 782-7300

2575 S 7TH St
Bethany Riverside
La Crosse, WI 54601-5429
Phone (608) 775-8200

400 Water Ave
Hillsboro, WI 54634-9054
Phone (608) 489-8000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
6295KSMDInternal Medicine Physician
52325WIMDInternal Medicine Physician
105904MNMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Gundersen Lutheran Express Care, Inc CurrentSince Jun 1, 2009 Accepting new patients
Tri-County Memorial Hospital, Inc. CurrentSince Nov 21, 2018 Accepting new patients
St. Joseph's Health Services, Inc. CurrentSince Mar 10, 2020 Accepting new patients
Tri-County Memorial Hospital, Inc. CurrentSince Jan 14, 2026 Accepting new patients
Gundersen Lutheran Medical Center Inc Current Accepting new patients
Gundersen Lutheran Medical Center Inc CurrentSince Jun 1, 2013 Accepting new patients
Tri-County Memorial Hospital, Inc. CurrentSince Nov 21, 2018 Accepting new patients
Memorial Hospital of Boscobel CurrentSince Jan 25, 2026 Accepting new patients
Moundview Memorial Hospital & Clinics, Inc. CurrentSince Jun 2, 2019 Accepting new patients
St. Joseph's Health Services, Inc. CurrentSince Mar 10, 2020 Accepting new patients
Moundview Memorial Hospital & Clinics, Inc Internal Medicine CurrentSince Jan 6, 2026 Accepting new patients
Moundview Memorial Hospital & Clinics, Inc. CurrentSince Jun 2, 2019 Accepting new patients
Memorial Hospital of Boscobel CurrentSince Jan 25, 2026 Accepting new patients
Gundersen Clinic LTD CurrentSince Jun 1, 2009 Accepting new patients
Gundersen Lutheran Medical Center, Inc CurrentSince Jun 1, 2013 Accepting new patients
Cogent Healthcare of Iowa, PC Internal Medicine CurrentSince Jan 31, 2017 Accepting new patients

Locations

701 10th St SE
Cedar Rapids, IA 52403
Phone (319) 398-6011

3 S 4th Ave
Marshalltown, IA 50158
Phone (641) 754-5145

210 9th St SE
Rochester, MN 55904
Phone (507) 529-6616

855 Mankato Ave
Winona, MN 55987
Phone (507) 454-3680

205 Parker St
Boscobel, WI 53805
Phone (608) 375-4112

402 W Lake St
Friendship, WI 53934
Phone (608) 339-3331

1836 South Ave
La Crosse, WI 54601
Phone (608) 788-8102

1910 South Ave
La Crosse, WI 54601
Phone (608) 775-2287

1600 Main St
Onalaska, WI 54650
Phone (608) 783-4681

37868 US Highway 18
Prairie du Chien, WI 53821
Phone (608) 357-2000

18601 Lincoln St
Whitehall, WI 54773
Phone (715) 538-1712

Interoperability endpoints

  • Direct secure messaging: bkusuma14259@direct.emplifyhealth.org

Organizations & group practices 16

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

View all 16

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454889600000",
    "number": "1073734133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1836 SOUTH AVE",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546015429",
            "telephone_number": "608-782-7300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1836 SOUTH AVE",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546015429",
            "telephone_number": "608-782-7300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUSUMA",
        "first_name": "BENNY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-02",
        "last_updated": "2016-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KS",
            "license": "6295",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "52325",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Crosse, WI

Sources for this page

Verify at the official NPI Registry.