Lakeview Neurorehab Center Midwest, Inc

Primary specialty

Rehabilitation Hospital UnitTaxonomy code 273Y00000X

Legal business name

LAKEVIEW NEUROREHAB CENTER MIDWEST, INC

Practice address

1701 Sharp Rd
Waterford, WI 53185-5214

Phone

(262) 534-7297

Fax

(262) 534-7257

NPI assigned

Dec 17, 2021

Organization subpart

Yes

Parent organization

LAKEVIEW NEUROREHAB CENTER MIDWEST, INCAs reported in NPPES

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

Authorized official

Name

Mr. Christopher Scott Slover

Title

Ceo

Phone

(511) 773-8076

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI2 enrollments

Enrollment records 2

Hospital certification: CCN 522005

Legal name

LAKEVIEW NEUROREHAB CENTER MIDWEST INC

Doing business as

LAKEVIEW SPECIALTY HOSPITAL AND REHAB

Certification status

Active

Provider type (POS)

Hospital – Long-term

Participating since

Oct 1, 1998

Last certification

Sep 9, 2011

Beds

39

Ownership / control type

Private (for profit)

Organization structure

CorporationProprietary

Incorporated

Sep 23, 1996 in WI

Enrollment address

1701 Sharp Road
Waterford, WI 53185-5214
Other Hospital Practice Location

Hospital subgroups

Long-term

Hospital certification: CCN 52TA05

Legal name

LAKEVIEW NEUROREHAB CENTER MIDWEST INC

Doing business as

LAKEVIEW SPECIALTY HOSPITAL & REHAB

Organization structure

CorporationProprietary

Incorporated

Sep 23, 1996 in WI

Enrollment address

1701 Sharp Rd
Waterford, WI 53185-5214
Hospital Rehabilitation Unit

Hospital subgroups

Rehabilitation unit

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Lakeview Neurorehab Center Midwest, Inc

  • Long Term Care Hospital
  • Waterford, WI
  • NPI 1396726873

  6709770274

  Same PAC ID

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Lakeview Neurorehab Center Midwest, Inc

  • Long Term Care Hospital
  • Waterford, WI
  • NPI 1396726873

  O20040311000908

  Same enrollment

Listed as

Lakeview Specialty Hospital & Rehab CenterCCN 52TA05

Ownership

For profit

Certified

Jan 1, 2023

Listed as

Lakeview Specialty Hospital & Rehab CenterCCN 522005

Ownership

For profit

Certified

Oct 1, 1998

Medicare certification status

ActiveFrom the Provider of Services file

Beds

39

Part of

Lakeview Neuro Rehab Ce

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

• Lakeview Neurorehab Center Midwest, Inc

  • Long Term Care Hospital
  • Waterford, WI
  • NPI 1396726873

  Lakeview Management Inc

  CMS ownership

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Robert M Gullberg, MD

  • Infectious Disease Physician
  • Racine, WI
  • NPI 1669402541
  NPD
• Merle R Orr, MD

  • Spinal Cord Injury Medicine Physician
  • Mequon, WI
  • NPI 1336193176
  NPD

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Mustansir Majeed, MD

  • Family Medicine Physician
  • Waterford, WI
  • NPI 1689778920

  Inpatient rehabilitation facility

  Care Compare affiliation
• Stefanie Ruffolo, M.D.

  • Internal Medicine Physician
  • Kenosha, WI
  • NPI 1548572696

  Long-term care hospital

  Care Compare affiliation

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

{
    "created_epoch": "1639699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687392000000",
    "number": "1083374029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 SHARP RD",
            "city": "WATERFORD",
            "state": "WI",
            "postal_code": "531855214",
            "telephone_number": "262-534-7297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 SHARP RD",
            "city": "WATERFORD",
            "state": "WI",
            "postal_code": "531855214",
            "telephone_number": "262-534-7297",
            "fax_number": "262-534-7257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKEVIEW NEUROREHAB CENTER MIDWEST, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LAKEVIEW NEUROREHAB CENTER MIDWEST, INC",
        "enumeration_date": "2021-12-17",
        "last_updated": "2023-06-22",
        "certification_date": "2023-06-22",
        "status": "A",
        "authorized_official_last_name": "SLOVER",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "511-773-8076",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "273Y00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Unit",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "283X00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Hospital",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11022100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nitesh Kumar, MD
• Satish Lahiri, MD
• Lakeview Care Partners, Inc.
• Lakeview Critical Care EMS, Inc
• Lakeview Healthcare Systems Waterford
• Lakeview Neurorehab Center Midwest, Inc
• Lakeview Neurorehab Center Midwest, Inc
• Lakeview Neurorehab Center Midwest, Inc.
• Jonathan Lancourt
• Ashlee Leidall, DPT

• Rehabilitation Hospital Unit in Waterford, WI
• Providers in Waterford, WI by specialty
• Rehabilitation Hospital Unit in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.