NPIMap

Organization Active NPI

Aurora Medical Group Inc

Doing business as Aurora Medical Group Lake Geneva

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Lake Geneva, WI
National Provider Identifier
1336296300
Registry record updated Sep 22, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
AURORA MEDICAL GROUP INC
Doing business as
Aurora Medical Group Lake Geneva
Practice address
146 E Geneva SQ
Lake Geneva, WI 53147-9694
Phone
(262) 249-5040
Fax
(262) 249-7146
NPI assigned
Jan 4, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2010

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

Authorized official

Name
Jeffery Bailet
Title
President
Phone
(414) 647-6322

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X Primary
Dialysis Equipment & Supplies (DME) 332BD1200X

Addresses

Primary practice location

146 E Geneva SQ
Lake Geneva, WI 53147-9694

Mailing address

5200 Virginia Way
4TH Floor L&C Dept
Brentwood, TN 37027-7569
Phone (615) 320-4521

Other identifiers 1

IdentifierTypeStateIssuer
1336296300MedicaidWI

Other names 1

  • Aurora Medical Group Lake Geneva Doing business as

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

650 N Edwards Blvd
Lake Geneva, WI 53147
Phone (262) 248-2502

NPI Registry JSON

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285113600000",
    "number": "1336296300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "4TH FLOOR L&C DEPT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569",
            "telephone_number": "615-320-4521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "146 E GENEVA SQ",
            "city": "LAKE GENEVA",
            "state": "WI",
            "postal_code": "531479694",
            "telephone_number": "262-249-5040",
            "fax_number": "262-249-7146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AURORA MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-04",
        "last_updated": "2010-09-22",
        "status": "A",
        "authorized_official_last_name": "BAILET",
        "authorized_official_first_name": "JEFFERY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "414-647-6322"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332BD1200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Dialysis Equipment & Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1336296300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aurora Medical Group Lake Geneva",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Geneva, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2010; 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.