NPIMap

Organization Active NPI

Surgical Associates of Neenah, S.C.

  • Surgery Physician
  • Neenah, WI
National Provider Identifier
1285792341
Registry record updated Feb 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
SURGICAL ASSOCIATES OF NEENAH, S.C.
Practice address
130 2ND St
100 Theda Clark Med Plaza, Suite 400
Neenah, WI 54956-2883
Phone
(920) 725-4527
Fax
(920) 725-0991
NPI assigned
Dec 4, 2006
Last updated
Feb 27, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2021

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

Authorized official

Name
Dr. Raymond F. Georgen, M.D.NPI 1912957457
Title
President
Phone
(920) 725-4527

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
Surgery Physician 208600000X NU Primary

Addresses

Primary practice location

130 2ND St
100 Theda Clark Med Plaza, Suite 400
Neenah, WI 54956-2883

Mailing address

100 Theda Clark Medical PLZ Ste 400
Neenah, WI 54956-2763
Phone (920) 725-4527

Other practice location 1

1405 Mill St
New London, WI 54961-2155
Phone (920) 531-2099

Other practice location 2

820 E Grant St Ste 230
Appleton, WI 54911-3441
Phone (920) 725-4527

Other practice location 3

100 County Road B
Shawano, WI 54166-7072
Phone (715) 524-2161

Other names 1

  • Midwest bariatric Solutions Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040804001098 WI Part B Supplier - Clinic/Group Practice 4486625258 Receives reassigned benefits from 39 practitioners
Practice locations: Waupaca, WI; Shawano, WI; New London, WI; Neenah, WI; Berlin, WI; Appleton, WI

National Provider Directory

National Provider Directory

Locations

820 E Grant St
Ste 230
Appleton, WI 54911
Phone (920) 725-4527

225 Memorial Dr
Ste 1010
Berlin, WI 54923
Phone (920) 725-4527

100 Theda Clark Medical Plz
Ste 400
Neenah, WI 54956
Phone (414) 725-4527

130 2nd St
#100
Neenah, WI 54956

130 2nd St
Ste 400
Neenah, WI 54956
Phone (920) 725-4527

200 Theda Clark Medical Plz
Ste 410
Neenah, WI 54956
Phone (920) 725-4527

Practitioners & affiliated clinicians

Practitioners 40

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 40

NPI Registry JSON

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614384000000",
    "number": "1285792341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 THEDA CLARK MEDICAL PLZ STE 400",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549562763",
            "telephone_number": "920-725-4527",
            "fax_number": "920-725-0991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 2ND ST",
            "address_2": "100 THEDA CLARK MED PLAZA, SUITE 400",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549562883",
            "telephone_number": "920-725-4527",
            "fax_number": "920-725-0991"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1405 Mill St",
            "address_purpose": "LOCATION",
            "city": "New London",
            "state": "WI",
            "postal_code": "549612155",
            "country_code": "US",
            "telephone_number": "920-531-2099",
            "fax_number": "920-725-0991",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "820 E Grant St Ste 230",
            "address_purpose": "LOCATION",
            "city": "Appleton",
            "state": "WI",
            "postal_code": "549113441",
            "country_code": "US",
            "telephone_number": "920-725-4527",
            "fax_number": "920-729-2378",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 County Road B",
            "address_purpose": "LOCATION",
            "city": "Shawano",
            "state": "WI",
            "postal_code": "541667072",
            "country_code": "US",
            "telephone_number": "715-524-2161",
            "fax_number": "715-524-1559",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SURGICAL ASSOCIATES OF NEENAH, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-04",
        "last_updated": "2021-02-27",
        "certification_date": "2021-02-27",
        "status": "A",
        "authorized_official_last_name": "GEORGEN",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_middle_name": "F.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "920-725-4527",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Midwest bariatric Solutions",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Midwest bariatric Solutions",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Neenah, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2021; 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.