Active NPI
Solidaritus Health Wisconsin SC
- Family Medicine Physician
- Oconomowoc, WI
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- SOLIDARITUS HEALTH WISCONSIN SC
- Practice address
- 915 Summit Ave
Oconomowoc, WI 53066-3921 - Phone
- (414) 348-8970
- NPI assigned
- Jun 12, 2025
- Last updated
- Jun 12, 2025
- Organization subpart
- Yes
- Parent organization
- SOLIDARITUS HEALTH WISCONSIN SC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Georgia Jaquette Smith
- Title
- Practice Manager
- Phone
- (715) 461-0463
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
915 Summit Ave
Oconomowoc, WI 53066-3921
Mailing address
1025 Connecticut Ave NW Ste 907
Washington, DC 20036-5434
Phone (888) 491-2951
Other names 1
- Solidaritus Health Oconomowoc
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 52D2325043 | Solidaritus Health Wisconsin SC | Certificate of waiver | Jun 4, 2027 |
National Provider Directory
National Provider Directory- Tax ID family
- Solidaritus Health Wisconsin SC
- Part of
- Solidaritus Health Wisconsin SC
Other organizations with this tax ID 3
Organizations that report the same tax identification number in the National Provider Directory.
-
- Family Medicine Physician
- Altoona, WI
- NPI 1790323608
-
- Family Medicine Physician
- Sheboygan, WI
- NPI 1861240103
-
- Family Medicine Physician
- Muskego, WI
- NPI 1982459582
Ownership & related parties
Parent organization (reported in NPPES) 1
This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.
-
- Family Medicine Physician
- Altoona, WI
- NPI 1790323608
Practitioners & affiliated clinicians
Practitioners 1
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.
-
- Oncology Registered Nurse
- Eau Claire, WI
- NPI 1154639359
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1749686400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1749686400000",
"number": "1104711605",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1025 CONNECTICUT AVE NW STE 907",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200365434",
"telephone_number": "888-491-2951"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "915 SUMMIT AVE",
"city": "OCONOMOWOC",
"state": "WI",
"postal_code": "530663921",
"telephone_number": "414-348-8970"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SOLIDARITUS HEALTH WISCONSIN SC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "SOLIDARITUS HEALTH WISCONSIN SC",
"enumeration_date": "2025-06-12",
"last_updated": "2025-06-12",
"certification_date": "2025-06-12",
"status": "A",
"authorized_official_last_name": "SMITH",
"authorized_official_first_name": "GEORGIA",
"authorized_official_middle_name": "JAQUETTE",
"authorized_official_title_or_position": "PRACTICE MANAGER",
"authorized_official_telephone_number": "715-461-0463"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Solidaritus Health Oconomowoc",
"code": "5",
"type": "Other Name"
}
]
}
Other providers in Oconomowoc, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- 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.