Active NPI
Benjamin T Skubal
- Certified Registered Nurse Anesthetist
- West Bend, WI
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 085261
- Practice address
- 3200 Pleasant Valley Rd
West Bend, WI 53095-9274 - Phone
- (262) 836-7300
- Fax
- (262) 836-7301
- NPI assigned
- Oct 2, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 085261 | WI | Primary |
Addresses
Primary practice location
3200 Pleasant Valley Rd
West Bend, WI 53095-9274
Mailing address
9200 W Wisconsin Ave
Milwaukee, WI 53226-3522
Phone (414) 805-2764
Other practice location 1
9200 W Wisconsin Ave
Milwaukee, WI 53226-3522
Phone (414) 805-2764
Other practice location 2
3212 Pleasant Valley Rd
West Bend, WI 53095-9274
Phone (262) 836-7300
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104135508 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110215000533 | WI | Practitioner - Certified Registered Nurse Anesthetist (Crna) | 7113107616 | Reassigns benefits to 2 organizations |
Care Compare profile
Medicare Care Compare- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 2010
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- The Medical College of Wisconsin Inc
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
Merit-based Incentive Payment System (MIPS)
- Final score
- 87.99 of 100
- Quality
- 82.81
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 77.15
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 085261 | WI | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Froedtert &the Medical College of Wisconsin Community Physicians, Inc. | Current | Accepting new patients | |
| Froedtert &the Medical College of Wisconsin Community Physicians, Inc. | Current | Accepting new patients | |
| The Medical College of Wisconsin, Inc. | Current | Accepting new patients |
Locations
W168N11237 Western Ave
Germantown, WI 53022
Phone (262) 253-5060
N74W12501 Leatherwood Ct
Menomonee Falls, WI 53051
Phone (414) 454-4744
9200 W Wisconsin Ave
Wauwatosa, WI 53226
Phone (414) 259-3000
8701 Watertown Plank Rd
Wauwatosa, WI 53226
Phone (414) 456-4100
1155 N Mayfair Rd
Wauwatosa, WI 53226
Phone (414) 955-5990
3200 Pleasant Valley Rd
West Bend, WI 53095
Phone (262) 334-5533
3212 Pleasant Valley Rd
West Bend, WI 53095
Phone (262) 306-6221
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.
-
- Internal Medicine Physician
- Menomonee Falls, WI
- NPI 1568787448
WI
-
- Durable Medical Equipment & Medical Supplies
- Wauwatosa, WI
- NPI 1154947224
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Milwaukee, WI
- NPI 1255334173
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1285977600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1714003200000",
"number": "1104135508",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9200 W WISCONSIN AVE",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532263522",
"telephone_number": "414-805-2764",
"fax_number": "414-777-4870"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3200 PLEASANT VALLEY RD",
"city": "WEST BEND",
"state": "WI",
"postal_code": "530959274",
"telephone_number": "262-836-7300",
"fax_number": "262-836-7301"
}
],
"practiceLocations": [
{
"address_1": "9200 W Wisconsin Ave",
"address_purpose": "LOCATION",
"city": "Milwaukee",
"state": "WI",
"postal_code": "532263522",
"country_code": "US",
"telephone_number": "414-805-2764",
"fax_number": "414-777-4870",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3212 Pleasant Valley Rd",
"address_purpose": "LOCATION",
"city": "West Bend",
"state": "WI",
"postal_code": "530959274",
"country_code": "US",
"telephone_number": "262-836-7300",
"fax_number": "262-836-7301",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SKUBAL",
"first_name": "BENJAMIN",
"middle_name": "T",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-10-02",
"last_updated": "2024-04-25",
"certification_date": "2024-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "WI",
"license": "085261",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1104135508",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}
Other providers in West Bend, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- 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.