Mayville Family Practice LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

48218-21 Issued in WI

Legal business name

MAYVILLE FAMILY PRACTICE LLC

Practice address

5595 County Road Z
West Bend, WI 53095-9224

Phone

(262) 339-3038

NPI assigned

Feb 14, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Charles Edward Sammis, DO

Title

Physician/Owner

Phone

(262) 339-3033

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1518566400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629849600000",
    "number": "1154821387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3545 MARTHA CT",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530958792",
            "telephone_number": "262-339-3033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5595 COUNTY ROAD Z",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530959224",
            "telephone_number": "262-339-3038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAYVILLE FAMILY PRACTICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-14",
        "last_updated": "2021-08-25",
        "certification_date": "2021-08-25",
        "status": "A",
        "authorized_official_last_name": "SAMMIS",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "262-339-3033",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "48218-21",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexander Gruber Marshall, LPC-IT, SAC-IT
• Devona Marshall, LPC
• Linda Jeanne Martenet, LPC IT
• Tonya Kathleen Maser, RN
• Betty L Mayer, PT
• Kerrie Marie Mazeika, MSW, LCSW
• Douglas Mazur, MS PT
• MB Counseling Center of West Bend, LLC
• Emily McCabe
• Andrea L McCarthy, P.T.

• Family Medicine Physician in West Bend, WI
• Providers in West Bend, 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 Aug 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.