Dermatopathology of Wisconsin SC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

52D0661946 Issued in WI

Legal business name

DERMATOPATHOLOGY OF WISCONSIN SC

Practice address

12805 W Burleigh Rd
Suite 200
Brookfield, WI 53005-3111

Phone

(262) 797-6434

Fax

(262) 797-6429

NPI assigned

Feb 3, 2006

Organization subpart

Yes

Parent organization

AMERIPATH INC.As reported in NPPES

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

Authorized official

Name

Darren Thomas Wheeler, MD

Title

Vice President

Phone

(702) 733-7866

Specialties & licenses 1

Addresses

Other identifiers 7

Other names 1

• Dermpath Diagnostics of WI Other name

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

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

CLIA laboratory certificates

Member of 1

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

• Quest Diagnostics Incorporated

  • Clinical Medical Laboratory
  • Albany, NY
  • NPI 1265202147

  Member Of

  NPD member

Locations

Practitioners 2

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

• Scott W. Kelley, MD

  • Dermatopathology (Pathology) Physician
  • Brookfield, WI
  • NPI 1700863685
  NPD (past)
• Melanie K. Trevino, MD

  • Dermatopathology (Pathology) Physician
  • Brookfield, WI
  • NPI 1740267780

  Dermatology

  NPD (past)

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

{
    "created_epoch": "1138924800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726790400000",
    "number": "1164494142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14275 MIDWAY RD STE 400",
            "city": "ADDISON",
            "state": "TX",
            "postal_code": "750013661",
            "telephone_number": "214-932-8018",
            "fax_number": "610-271-4245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12805 W BURLEIGH RD",
            "address_2": "SUITE 200",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530053111",
            "telephone_number": "262-797-6434",
            "fax_number": "262-797-6429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOPATHOLOGY OF WISCONSIN SC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AMERIPATH INC.",
        "enumeration_date": "2006-02-03",
        "last_updated": "2024-09-20",
        "certification_date": "2024-09-20",
        "status": "A",
        "authorized_official_last_name": "WHEELER",
        "authorized_official_first_name": "DARREN",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "702-733-7866",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "WI",
            "license": "52D0661946",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1164494142",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5585170",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32911800",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0765271",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "14900",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "749475100",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "52D1105706",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dermpath Diagnostics of WI",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Dermpath Diagnostics of WI",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Bailey Denis
• Sean Denny, BCBA
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• Kris Desotelle, PTA
• Lindsay Detienne
• Derritt James Dietlmeier
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• Clinical Medical Laboratory in Brookfield, WI
• Providers in Brookfield, WI by specialty
• Clinical Medical Laboratory in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 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.