NPIMap

Organization Active NPI

Horizon Healthcare, Inc

  • Nurse Practitioner
  • Milwaukee, WI
National Provider Identifier
1194158915
Registry record updated Sep 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
HORIZON HEALTHCARE, INC
Practice address
633 W Wisconsin Ave
Suite 1810
Milwaukee, WI 53203-1908
Phone
(414) 810-2967
Fax
(262) 641-9126
NPI assigned
Aug 15, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2013

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

Authorized official

Name
Darren Matavka
Title
Executive Vice President
Phone
(262) 641-9050

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X 2174 WI
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

633 W Wisconsin Ave
Suite 1810
Milwaukee, WI 53203-1908

Mailing address

285 N Janacek Rd
Brookfield, WI 53045-6102
Phone (262) 641-9050

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040124000318 WI Part B Supplier - Clinic/Group Practice 0749182160 Receives reassigned benefits from 21 practitioners
18 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Milwaukee, WI; Waukesha, WI; Racine, WI; Kenosha, WI

Other NPIs on the same Medicare enrollment 12

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1376524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1378857600000",
    "number": "1194158915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "285 N JANACEK RD",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530456102",
            "telephone_number": "262-641-9050",
            "fax_number": "262-641-9126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "633 W WISCONSIN AVE",
            "address_2": "SUITE 1810",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532031908",
            "telephone_number": "414-810-2967",
            "fax_number": "262-641-9126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HORIZON HEALTHCARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-15",
        "last_updated": "2013-09-11",
        "status": "A",
        "authorized_official_last_name": "MATAVKA",
        "authorized_official_first_name": "DARREN",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT",
        "authorized_official_telephone_number": "262-641-9050"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": "WI",
            "license": "2174",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2013; 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.