Individual provider Active NPI

Horace Pei Lo, M.D.

  • Surgery Physician
  • Berlin, WI
National Provider Identifier
1114988466
Registry record updated Jun 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
39102-020 Issued in WI
Practice address
225 Memorial Dr Ste 2000
Berlin, WI 54923-1243
Phone
(920) 361-5340
NPI assigned
Mar 28, 2006
Last updated
Jun 9, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 39102-020 WI Primary

Addresses

Primary practice location

225 Memorial Dr Ste 2000
Berlin, WI 54923-1243

Mailing address

225 Memorial Dr Ste 2000
Berlin, WI 54923-1243
Phone (920) 361-5340

Other practice location 1

9515 Holy Cross Ln
Breese, IL 62230-3618
Phone (618) 526-8430

Other identifiers 1

IdentifierTypeStateIssuer
1114988466MedicaidWI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address hlo394937@ewd.direct.hshs.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, IL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20061206000564 WI Practitioner - General Surgery 4688673395 Reassigns benefits to 3 organizations
I20230622001831 IL Practitioner - General Surgery 4688673395

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Agnesian Healthcare IncGroup PAC ID 1658289624, 392 clinicians

Practice addresses (Care Compare)

608 W Brown St
Waupun, WI 53963-1702
Phone (920) 324-6800

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy37
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)1-10
Mastectomy1-10
Upper gastrointestinal (GI) endoscopy for acid reflux47
Melanoma (skin cancer) excision1-10
Removal of tissue11
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
39102-020WIMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prairie Ridge Health, Inc. CurrentSince Jul 16, 2023 Accepting new patients
Watertown Physician Practices LLC CurrentSince May 19, 2023 Accepting new patients
Agnesian Healthcare, Inc CurrentSince Jul 1, 2023 Accepting new patients
Agnesian Healthcare Inc CurrentSince Jul 1, 2023 Accepting new patients
Prairie Ridge Health Inc. CurrentSince Jul 16, 2023 Accepting new patients
Watertown Physician Practices LLC Current Accepting new patients

Locations

225 Memorial Dr
Berlin, WI 54923
Phone (920) 361-1313

225 Memorial Dr
Ste 2000
Berlin, WI 54923
Phone (920) 361-5340

1515 Park Ave
Columbus, WI 53925
Phone (920) 623-1200

420 E Division St
Fond du Lac, WI 54935
Phone (920) 923-7400

430 E Division St
Fond du Lac, WI 54935
Phone (920) 926-4200

360 S Mountin Dr
Mayville, WI 53050
Phone (920) 387-2111

845 Parkside St
Ripon, WI 54971
Phone (920) 748-3101

933 Newbury St
Ripon, WI 54971
Phone (920) 748-0430

123 Hospital Dr
Ste 2000
Watertown, WI 53098
Phone (920) 206-3042

1507 Doctors Ct
Watertown, WI 53094
Phone (920) 261-4111

608 W Brown St
Waupun, WI 53963
Phone (920) 324-6800

Interoperability endpoints

  • Direct secure messaging: hlo119919@direct.thedacare.org
  • Direct secure messaging: hlo332769@direct-ehr-ssmhc.com
  • Direct secure messaging: hlo394937@ewd.direct.hshs.org

Organizations & group practices 6

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.

Hospital & facility affiliations 4

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": "1143504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686268800000",
    "number": "1114988466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 MEMORIAL DR STE 2000",
            "city": "BERLIN",
            "state": "WI",
            "postal_code": "549231243",
            "telephone_number": "920-361-5340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 MEMORIAL DR STE 2000",
            "city": "BERLIN",
            "state": "WI",
            "postal_code": "549231243",
            "telephone_number": "920-361-5340"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9515 Holy Cross Ln",
            "address_purpose": "LOCATION",
            "city": "Breese",
            "state": "IL",
            "postal_code": "622303618",
            "country_code": "US",
            "telephone_number": "618-526-8430",
            "fax_number": "618-526-7275",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LO",
        "first_name": "HORACE",
        "middle_name": "PEI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-28",
        "last_updated": "2023-06-09",
        "certification_date": "2023-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WI",
            "license": "39102-020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1114988466",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hlo394937@ewd.direct.hshs.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "9515 Holy Cross Ln",
            "city": "Breese",
            "state": "IL",
            "country_code": "US",
            "postal_code": "622303618",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Berlin, WI

Sources for this page

Verify at the official NPI Registry.