Wisconsin Spine and Pain SC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

WISCONSIN SPINE AND PAIN SC

Practice address

1000 Gateway Court Suite 100
West Bend, WI 53095-8541

Phone

(920) 204-6758

NPI assigned

Sep 27, 2024

Last updated

Sep 27, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Michael JungNPI 1861665747

Title

MD

Phone

(414) 455-1153

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Other NPIs with the same Medicare PAC ID 4

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

• Wisconsin Spine and Pain SC

  • Durable Medical Equipment & Medical Supplies
  • Appleton, WI
  • NPI 1285452391

  0345665469

  Same PAC ID
• Wisconsin Spine and Pain SC

  • Durable Medical Equipment & Medical Supplies
  • Green Bay, WI
  • NPI 1649098856

  0345665469

  Same PAC ID
• Wisconsin Spine and Pain SC

  • Interventional Pain Medicine Physician
  • Sheboygan, WI
  • NPI 1790309276

  0345665469

  Same PAC ID
• Wisconsin Spine and Pain SC

  • Durable Medical Equipment & Medical Supplies
  • Sheboygan, WI
  • NPI 1982422192

  0345665469

  Same PAC ID

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Wisconsin Spine and Pain SC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

• Wisconsin Spine and Pain SC

  • Durable Medical Equipment & Medical Supplies
  • Appleton, WI
  • NPI 1285452391
  NPD tax ID
• Wisconsin Spine and Pain SC

  • Durable Medical Equipment & Medical Supplies
  • Waukesha, WI
  • NPI 1487472593
  NPD tax ID
• Wisconsin Spine and Pain SC

  • Durable Medical Equipment & Medical Supplies
  • Green Bay, WI
  • NPI 1649098856
  NPD tax ID
• Wisconsin Spine and Pain SC

  • Durable Medical Equipment & Medical Supplies
  • Sheboygan, WI
  • NPI 1982422192
  NPD tax ID

Locations

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.

• Michael Jung, M.D.

  • Pain Medicine Physician
  • West Bend, WI
  • NPI 1861665747
  NPD (past) Authorized official

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

{
    "created_epoch": "1727395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727395200000",
    "number": "1154149367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DEPT. CH 17057",
            "city": "PALATINE",
            "state": "IL",
            "postal_code": "600557057",
            "telephone_number": "920-204-6758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 GATEWAY COURT SUITE 100",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530958541",
            "telephone_number": "920-204-6758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISCONSIN SPINE AND PAIN SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-27",
        "last_updated": "2024-09-27",
        "certification_date": "2024-09-27",
        "status": "A",
        "authorized_official_last_name": "JUNG",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "414-455-1153"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael James Wiedmeyer, L.P.N.
• Wild Hope Counseling & Wellness, LLC
• Elizabeth Anne Wildt, R.N.
• Abby Anne Wilson, COTA
• Wisconsin Dental Group, S.C. (ForwardDental West Bend)
• Sarah Witte, LCSW
• Chelsea Wolf
• Jill Elizabeth Wolf, MSW, CAPSW, SAC-IT
• Kay Marie Wolff, NP
• Michal Woll

• Durable Medical Equipment & Medical Supplies in West Bend, WI
• Providers in West Bend, WI by specialty
• Durable Medical Equipment & Medical Supplies in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 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.

Verify at the official NPI Registry.