Sophos Georgio Geroulis, M.D.
Individual provider Active NPI Neurology Physician · Summit, WI
NPI 1295820637 · NPPES record last updated Dec 28, 2017
Key facts
- NPI
- 1295820637
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Neurology Physician 2084N0400X
- License
- 49566-020 (WI)
- Practice address
- 36500 Aurora Dr
Summit, WI 53066-4899 - Phone
- (262) 434-5000
- NPI assigned
- Oct 3, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 17
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Neurology
- Education
- Other, 2003
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Prohealth Medical Group Inc
Practice addresses (Care Compare)
721 American Ave
Suite 108
Waukesha, WI 53188-5071
Phone (262) 928-8200
Hospital & facility affiliations
- Waukesha Memorial Hospital
- Oconomowoc Memorial Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Skin biopsy | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100107000073 | WI | Practitioner - Neurology |
4587705942 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 49566-020 | WI | MD | Sleep Medicine (Psychiatry & Neurology) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ascension Medical Group-Southeast Wisconsin Inc | Neurology | Current |
Accepting new patients |
| Prohealth Medical Group Inc | Current |
Accepting new patients | |
| Prohealth Medical Group Inc. | Neurology | Current |
Accepting new patients |
| Columbia St. Mary'S Hospital Milwaukee Inc | Current |
Accepting new patients | |
| Columbia St. Mary'S Hospital Milwaukee, Inc | Current |
Accepting new patients | |
| Prohealth Medical Group Inc | Past | Accepting new patients | |
| Braincare, LLC | Past |
Accepting new patients |
Locations
13950 W Capitol Dr
Brookfield, WI 53005
Phone (414) 302-5400
N143W6515 Pioneer Rd
Cedarburg, WI 53012
Phone (262) 377-2495
W168N11237 Western Ave
Germantown, WI 53022
Phone (262) 253-5060
N112W15415 Mequon Rd
Germantown, WI 53022
Phone (262) 250-7800
10911 N Port Washington Rd
Mequon, WI 53092
Phone (262) 241-2080
3237 S 16th St
Milwaukee, WI 53215
Phone (414) 647-5000
2311 N Prospect Ave
Milwaukee, WI 53211
Phone (414) 319-3000
2350 N Lake Dr
Ste 400
Milwaukee, WI 53211
Phone (414) 270-1633
3100 Superior Ave
Sheboygan, WI 53081
Phone (800) 472-6710
36500 Aurora Dr
Summit, WI 53066
Phone (262) 434-1000
N57W24950 N Corporate Cir
Sussex, WI 53089
Phone (262) 544-4411
N14W23900 Stone Ridge Dr
Waukesha, WI 53188
Phone (262) 549-3030
725 American Ave
Waukesha, WI 53188
Phone (262) 544-2011
721 American Ave
Ste 108
Waukesha, WI 53188
Phone (262) 928-2570
N17W24100 Riverwood Dr
Waukesha, WI 53188
Phone (262) 820-3093
201 N Mayfair Rd
Fl 2
Wauwatosa, WI 53226
Phone (414) 771-8228
801 S 70th St
West Allis, WI 53214
Phone (414) 773-6600
1700 W Paradise Dr
West Bend, WI 53095
Phone (262) 334-3451
Interoperability endpoints
- sgeroulis38195@direct.phci.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | 49566-020 | WI | Yes |
| Clinical Neurophysiology Physician | 2084N0600X | 49566-020 | WI | |
| Sleep Medicine (Psychiatry & Neurology) Physician | 2084S0012X | 49566-020 | WI |
Addresses
Primary practice location
36500 Aurora Dr
Summit, WI 53066-4899
Mailing address
PO Box 19070
Green Bay, WI 54307-9070
Phone (920) 496-4700
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295820637 | Medicaid | WI | |
| 27-5013474 | Other | WI | NEUROQUEST, LLC |
Other providers in Summit, WI
- Rachel Lorraine Fournogerakis
- Kathryn Eileen Gallagher
- Peter Anthony Garza Jr.
- James J Gatto
- Christopher George
- Jamie L Goehner
- Elaine Gonya
- Kira Greenwood
- Judith A Gresky
- Christina Grimord
All providers in Summit, WI · Neurology Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 28, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.