Individual provider Active NPI

Gokulakrishnan Balasubramanian, M.D.

  • Gastroenterology Physician
  • Milwaukee, WI
National Provider Identifier
1104079177
Registry record updated Sep 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
62348 Issued in WI
Practice address
9200 W Wisconsin Avenue
Division of Gastroenterology
Milwaukee, WI 53226-3522
Phone
(414) 805-3310
Fax
(414) 805-3885
NPI assigned
Nov 3, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 62348 WI Primary

Addresses

Primary practice location

9200 W Wisconsin Avenue
Division of Gastroenterology
Milwaukee, WI 53226-3522

Mailing address

9200 W Wisconsin Avenue
Division of Gastroenterology
Milwaukee, WI 53226-3522
Phone (414) 805-3310

Other identifiers 1

IdentifierTypeStateIssuer
0230010MedicaidOH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231008000138 WI Practitioner - Gastroenterology 8628225042 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Medical College of Wisconsin IncGroup PAC ID 2668384371, 2,092 clinicians

Practice addresses (Care Compare)

8701 W Watertown Plank
Milwaukee, WI 53226-3548
Phone (414) 805-3666

8701 Watertown Plank Rd
Room 4041 MFRC
Milwaukee, WI 53226-3548
Phone (414) 805-3666

Hospital & facility affiliations

  • Froedtert Memorial Lutheran Hospital Hospital, Milwaukee, WI, CCN 520177

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy54
Upper gastrointestinal (GI) endoscopy for acid reflux96

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
The Medical College of Wisconsin, Inc. Internal Medicine CurrentSince Sep 18, 2023 Accepting new patients
The Medical College of Wisconsin Inc Past Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

8701 Watertown Plank Rd
Wauwatosa, WI 53226
Phone (414) 456-4100

9200 W Wisconsin Ave
Wauwatosa, WI 53226
Phone (414) 259-3000

Interoperability endpoints

  • Direct secure messaging: gbalasubramanianmd158576@direct.froedtert.com

Organizations & group practices 3

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1225670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694649600000",
    "number": "1104079177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9200 W WISCONSIN AVENUE",
            "address_2": "DIVISION OF GASTROENTEROLOGY",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532263522",
            "telephone_number": "414-805-3310",
            "fax_number": "414-805-3885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9200 W WISCONSIN AVENUE",
            "address_2": "DIVISION OF GASTROENTEROLOGY",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532263522",
            "telephone_number": "414-805-3310",
            "fax_number": "414-805-3885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALASUBRAMANIAN",
        "first_name": "GOKULAKRISHNAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-11-03",
        "last_updated": "2023-09-14",
        "certification_date": "2023-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "WI",
            "license": "62348",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0230010",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.