Waukesha Surgicenter, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

WAUKESHA SURGICENTER, LLC

Practice address

813 W Moreland Blvd
Waukesha, WI 53188-2963

Phone

(262) 297-7246

NPI assigned

Dec 22, 2020

Organization subpart

No

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

Authorized official

Name

Karen Marie Bewer, RN

Title

Administrative Officer

Phone

(262) 297-7246

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Listed as

Waukesha Surgicenter LLCCCN 52C0001132

Medicare certification status

ActiveFrom the Provider of Services file

Tax ID family

Waukesha Surgicenter2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Waukesha Surgicenter, LLC

  • Non-Pharmacy Dispensing Site
  • Waukesha, WI
  • NPI 1245958586
  NPD tax ID

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Pain Physicians of Wisconsin, SC

  • Interventional Pain Medicine Physician
  • Milwaukee, WI
  • NPI 1679119689

  Member Of

  NPD member

Practitioners 4

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

• Joseph Roel Reyes, DO

  • Pain Medicine (Anesthesiology) Physician
  • Greenfield, WI
  • NPI 1528054947
  Medicare reassignment NPD
• Douglas Keehn, DO

  • Pain Medicine (Anesthesiology) Physician
  • Madison, WI
  • NPI 1942277751
  NPD (past)
• Jacob Pfeiffer

  • Orthopaedic Surgery Physician
  • Franklin, WI
  • NPI 1609230044
  NPD (past)
• Andrzej Staszkiewicz, MD

  • Pain Medicine (Anesthesiology) Physician
  • Chicago, IL
  • NPI 1689866717
  NPD (past)

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

{
    "created_epoch": "1608595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620086400000",
    "number": "1164019485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "813 W MORELAND BLVD",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531882963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "813 W MORELAND BLVD",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531882963",
            "telephone_number": "262-297-7246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAUKESHA SURGICENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-22",
        "last_updated": "2021-05-04",
        "certification_date": "2021-05-04",
        "status": "A",
        "authorized_official_last_name": "BEWER",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "ADMINISTRATIVE OFFICER",
        "authorized_official_telephone_number": "262-297-7246",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Stephanie Renee Weare, CPS

• Ambulatory Surgical Clinic/Center in Waukesha, WI
• Providers in Waukesha, WI by specialty
• Ambulatory Surgical Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2021; 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.