NPIMap

Organization Active NPI

Western Wisconsin Medical Associates

  • Primary Care Clinic/Center
  • River Falls, WI
National Provider Identifier
1255324752
Registry record updated Aug 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
WESTERN WISCONSIN MEDICAL ASSOCIATES
Practice address
1687 E Division St
River Falls, WI 54022-1571
Phone
(715) 425-6701
Fax
(715) 426-3994
NPI assigned
Aug 30, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2014

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

Authorized official

Name
Kerith W Lijewski, MDNPI 1093708588
Title
Medical Director
Phone
(715) 425-6701

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
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

1687 E Division St
River Falls, WI 54022-1571

Mailing address

1687 E Division St
River Falls, WI 54022-1571
Phone (715) 425-6701

Other identifiers 1

IdentifierTypeStateIssuer
32748700MedicaidWI

Other names 1

  • Vibrant Health Family Clinics Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040119000047 WI Part B Supplier - Clinic/Group Practice 8224939665 Receives reassigned benefits from 18 practitioners
Practice locations: River Falls, WI; Spring Valley, WI; Ellsworth, WI

National Provider Directory

National Provider Directory

Locations

144 S Plum St
Ellsworth, WI 54011
Phone (715) 273-5041

Interoperability endpoints

  • Direct secure messaging: christopher.tashjian@vibranthealth.cernerdirect.com
  • Direct secure messaging: gregory.miller@vibranthealth.cernerdirect.com
  • Direct secure messaging: monica.pesavento@vibranthealth.cernerdirect.com
  • Direct secure messaging: ben.morgan@vibranthealth.cernerdirect.com
  • Direct secure messaging: david.gregg@vibranthealth.cernerdirect.com
  • Direct secure messaging: amber.morgan@vibranthealth.cernerdirect.com
  • Direct secure messaging: kurt.helmrick@vibranthealth.cernerdirect.com
  • Direct secure messaging: jeffrey.larsen@vibranthealth.cernerdirect.com
  • Direct secure messaging: kelle.anderson1@vibranthealth.cernerdirect.com

Practitioners & affiliated clinicians

Practitioners 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1125360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407974400000",
    "number": "1255324752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1687 E DIVISION ST",
            "city": "RIVER FALLS",
            "state": "WI",
            "postal_code": "540221571",
            "telephone_number": "715-425-6701",
            "fax_number": "715-426-3994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1687 E DIVISION ST",
            "city": "RIVER FALLS",
            "state": "WI",
            "postal_code": "540221571",
            "telephone_number": "715-425-6701",
            "fax_number": "715-426-3994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN WISCONSIN MEDICAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-30",
        "last_updated": "2014-08-14",
        "status": "A",
        "authorized_official_last_name": "LIJEWSKI",
        "authorized_official_first_name": "KERITH",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "715-425-6701",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32748700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vibrant Health Family Clinics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in River Falls, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2014; 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.