Pisang LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

52325-20 Issued in WI

Legal business name

PISANG LLC

Practice address

37868 US Highway 18
Prairie Du Chien, WI 53821-8416

Phone

(702) 453-3799

Fax

(702) 453-5741

NPI assigned

Dec 29, 2015

Last updated

Dec 29, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Benny Kusuma, M.D.

Title

Sole Owner

Phone

(316) 209-1424

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1451347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1451347200000",
    "number": "1316302797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3602",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546023602",
            "telephone_number": "702-453-3799",
            "fax_number": "702-453-5741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "37868 US HIGHWAY 18",
            "city": "PRAIRIE DU CHIEN",
            "state": "WI",
            "postal_code": "538218416",
            "telephone_number": "702-453-3799",
            "fax_number": "702-453-5741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PISANG LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-29",
        "last_updated": "2015-12-29",
        "status": "A",
        "authorized_official_last_name": "KUSUMA",
        "authorized_official_first_name": "BENNY",
        "authorized_official_title_or_position": "SOLE OWNER",
        "authorized_official_telephone_number": "316-209-1424",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "52325-20",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "54950",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.