Active NPI
Clarence E Kusik
- Dentist
- Okauchee, WI
National Provider Identifier
1245407550
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 5000432015
- Practice address
- N50 W34838 Wisconsin Ave.
Okauchee, WI 53069 - Phone
- (262) 567-3171
- NPI assigned
- May 15, 2008
- Last updated
- Feb 3, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Clinic/Center | 261QD0000X | 5000432-15 | WI | |
| Dentist | 122300000X | 5000432015 | WI | Primary |
Addresses
Primary practice location
N50 W34838 Wisconsin Ave.
Okauchee, WI 53069
Mailing address
N50 W34838 Wisconsin Ave.
Okauchee, WI 53069
Phone (262) 567-3171
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38380800 | Medicaid | WI | |
| 33506100 | Medicaid | WI | |
| 1831369008 | Other | MAYFAIR DENTAL S.C. |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5000432015 | WI | MD | Dentist |
| 5000432-15 | WI | MD | Dental Clinic/Center |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1210809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1643846400000",
"number": "1245407550",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "N50 W34838 WISCONSIN AVE.",
"city": "OKAUCHEE",
"state": "WI",
"postal_code": "53069",
"telephone_number": "262-567-3171"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "N50 W34838 WISCONSIN AVE.",
"city": "OKAUCHEE",
"state": "WI",
"postal_code": "53069",
"telephone_number": "262-567-3171"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KUSIK",
"first_name": "CLARENCE",
"middle_name": "E",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-05-15",
"last_updated": "2022-02-03",
"certification_date": "2022-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "261QD0000X",
"taxonomy_group": "",
"desc": "Clinic/Center, Dental",
"state": "WI",
"license": "5000432-15",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WI",
"license": "5000432015",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "38380800",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "33506100",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAYFAIR DENTAL S.C.",
"identifier": "1831369008",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Okauchee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.