NPIMap

Organization Active NPI

Medsource LLC

  • Durable Medical Equipment & Medical Supplies
  • Hales Corners, WI
National Provider Identifier
1275847725
Registry record updated Nov 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
203.001082 Issued in IL
Legal business name
MEDSOURCE LLC
Practice address
5300 S 108TH St Ste 19
Hales Corners, WI 53130-1368
Phone
(262) 446-4850
Fax
(262) 446-4851
NPI assigned
Jul 27, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2020

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

Authorized official

Name
Mr. Eric Rohde
Title
Owner
Phone
(309) 664-7930

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 203.001082 IL Primary

Addresses

Primary practice location

5300 S 108TH St Ste 19
Hales Corners, WI 53130-1368

Mailing address

PO Box 1248
Bloomington, IL 61702-1248
Phone (309) 664-7930

Other identifiers 1

IdentifierTypeStateIssuer
203.001082OtherILLICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110120000664 WI DME Supplier - Medical Supply Company With Orthotic Personnel 3072726967 Practice locations: Hales Corners, WI

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

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

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Medsource LLC5300 S 108TH St, Hales Corners, WI 53130-1368(262) 044-6485 Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Blood Glucose Monitors/Supplies (Mail Order)|Heat & Cold Applications|Neuromuscular Elect Stimulators (NMES)/Supplies|Osteogenesis Stimulators|Pneumatic Compression Devices and/or Supplies|(TENS) Transcutaneous Electrical N… Accepts assignmentParticipating since Jan 1, 2008

National Provider Directory

National Provider Directory
Tax ID family
Medsource LLC7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

5300 S 108th St
Ste 19
Hales Corners, WI 53130
Phone (262) 446-4850

414 W Moreland Blvd
Ste 108
Waukesha, WI 53188

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1280188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606694400000",
    "number": "1275847725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1248",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617021248",
            "telephone_number": "309-664-7930",
            "fax_number": "309-664-7931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5300 S 108TH ST STE 19",
            "city": "HALES CORNERS",
            "state": "WI",
            "postal_code": "531301368",
            "telephone_number": "262-446-4850",
            "fax_number": "262-446-4851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDSOURCE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-27",
        "last_updated": "2020-11-30",
        "certification_date": "2020-11-30",
        "status": "A",
        "authorized_official_last_name": "ROHDE",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "309-664-7930",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "IL",
            "license": "203.001082",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "203.001082",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hales Corners, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2020; 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.