NPIMap

Organization Active NPI

Polykarpos Anesthesia LLC

  • Anesthesiology Physician
  • Pleasant Prairie, WI
National Provider Identifier
1154850972
Registry record updated Jun 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
POLYKARPOS ANESTHESIA LLC
Practice address
8400 Lakeview Pkwy Ste 800
Pleasant Prairie, WI 53158-5819
Phone
(705) 275-7799
NPI assigned
Jun 6, 2017
Last updated
Jun 6, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2017

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

Authorized official

Name
Aristeidie Diveris, MDNPI 1013926112
Title
Authorized Official
Phone
(847) 309-9896

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X NU Primary

Addresses

Primary practice location

8400 Lakeview Pkwy Ste 800
Pleasant Prairie, WI 53158-5819

Mailing address

825 N Sheridan Rd
Lake Forest, IL 60045-2226

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171016000281 WI Part B Supplier - Clinic/Group Practice 9436424629 Receives reassigned benefits from 16 practitioners
Practice locations: Pleasant Prairie, WI

National Provider Directory

National Provider Directory

Locations

8400 Lakeview Pkwy
Pleasant Prairie, WI 53158
Phone (262) 697-7295

Practitioners & affiliated clinicians

Practitioners 28

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.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1496707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1496707200000",
    "number": "1154850972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 N SHERIDAN RD",
            "city": "LAKE FOREST",
            "state": "IL",
            "postal_code": "600452226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8400 LAKEVIEW PKWY STE 800",
            "city": "PLEASANT PRAIRIE",
            "state": "WI",
            "postal_code": "531585819",
            "telephone_number": "705-275-7799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POLYKARPOS ANESTHESIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-06",
        "last_updated": "2017-06-06",
        "status": "A",
        "authorized_official_last_name": "DIVERIS",
        "authorized_official_first_name": "ARISTEIDIE",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "847-309-9896",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pleasant Prairie, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2017; 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.