Southeastern Pediatrics, SC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

41265 Issued in WI

Legal business name

SOUTHEASTERN PEDIATRICS, SC

Practice address

10625 W North Ave Ste 326
Wauwatosa, WI 53226-2315

Phone

(414) 771-0500

Fax

(414) 771-0363

NPI assigned

Apr 17, 2013

Organization subpart

No

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

Authorized official

Name

Ratidzai Rioga, MDNPI 1437215001

Title

President

Phone

(414) 771-0500

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Southeastern Pediatrics, SC

  • Case Management Agency
  • Wauwatosa, WI
  • NPI 1871403394
  NPPES parent name

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ratidzai Rioga, MD

  • Pediatric Adolescent Medicine Physician
  • Wauwatosa, WI
  • NPI 1437215001

  Family Medicine

  Medicare reassignment NPD Authorized official
• Shanna Marie Johnson, FNP-BC

  • Family Nurse Practitioner
  • Milwaukee, WI
  • NPI 1386940575
  NPD

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

{
    "created_epoch": "1366156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715731200000",
    "number": "1154765410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7592 SOLUTIONS CTR # 777592",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606777005",
            "telephone_number": "262-641-3700",
            "fax_number": "262-641-3719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10625 W NORTH AVE STE 326",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532262315",
            "telephone_number": "414-771-0500",
            "fax_number": "414-771-0363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN PEDIATRICS, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-17",
        "last_updated": "2024-05-15",
        "certification_date": "2024-05-15",
        "status": "A",
        "authorized_official_last_name": "RIOGA",
        "authorized_official_first_name": "RATIDZAI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "414-771-0500",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "41265",
            "primary": true
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "WI",
            "license": "41265",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew A Solberg, MD
• Solicitude, Inc. (Home Instead Senior Care #315)
• Keeley Sommers, OTR
• Khyati Soni, D.O.
• Antonio Soto
• Southeastern Pediatrics, SC
• Ivana Spaciel, APN
• Rachael Spalding, PHD
• Gabrielle Marie Sparangis, RN
• Donna Spearman, LPN

• Family Medicine Physician in Wauwatosa, WI
• Providers in Wauwatosa, WI by specialty
• Family Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.