Active NPI
Gwenn K. Pavlovitz, M.D.
- Surgery Physician
- Grafton, WI
National Provider Identifier
1447289566
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 27056
- Practice address
- 975 Port Washington Road
Suite 320
Grafton, WI 53024-9201 - Phone
- (262) 387-8100
- NPI assigned
- Jul 1, 2006
- Last updated
- May 24, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 27056 | WI | Primary |
Addresses
Primary practice location
975 Port Washington Road
Suite 320
Grafton, WI 53024-9201
Mailing address
3003 W Good Hope Rd
Milwaukee, WI 53209-2042
Phone (414) 352-3100
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00914018 | Other | WI | RR MEDICARE |
| 30668300 | Medicaid | WI |
Other names 1
- Gwenn K. Graboyes
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 27056 | WI | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advanced Healthcare SC | Surgery | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151712000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1306195200000",
"number": "1447289566",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3003 W GOOD HOPE RD",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532092042",
"telephone_number": "414-352-3100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "975 PORT WASHINGTON ROAD",
"address_2": "SUITE 320",
"city": "GRAFTON",
"state": "WI",
"postal_code": "530249201",
"telephone_number": "262-387-8100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAVLOVITZ",
"first_name": "GWENN",
"middle_name": "K.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-01",
"last_updated": "2011-05-24",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "WI",
"license": "27056",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "P00914018",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30668300",
"state": "WI"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "GWENN",
"last_name": "GRABOYES",
"middle_name": "K.",
"credential": "M.D.",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Grafton, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.