Geneva Surgical Suites, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

GENEVA SURGICAL SUITES, LLC

Practice address

119 Elizabeth Lane
Genoa City, WI 53128-2124

Phone

(262) 295-1213

Fax

(262) 295-1221

NPI assigned

Feb 22, 2017

Last updated

May 12, 2020By 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

Kristen Roeker

Title

Business Administrator

Phone

(262) 295-1216

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1447799580. Details of each certification follow.

• CCN 520211 Hospital · Terminated · Name & address match · Details

Hospital certification: CCN 520211

Legal name

GENEVA SURGICAL SUITES LLC

Certification status

Terminated Other: provider status change, Jul 23, 2020

Provider type (POS)

Hospital – Short-term

Participating since

May 14, 2020

Last certification

May 14, 2020

Beds

1

Ownership / control type

Private (for profit)

Facility address

119 Elizabeth Lane
Genoa City, WI 53128

Listed as

Geneva Surgical Suites Dba Geneva Surgical Suites LLCCCN 52C0001120

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 2

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.

• Gregory Drake, D.O.

  • Adult Reconstructive Orthopaedic Surgery Physician
  • Elk Grove Village, IL
  • NPI 1871507889
  NPD
• Gregory T. Brebach, M.D.

  • Orthopaedic Surgery Physician
  • Barrington, IL
  • NPI 1598751034
  NPD (past)

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

{
    "created_epoch": "1487721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589241600000",
    "number": "1447799580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 ELIZABETH LN",
            "city": "GENOA CITY",
            "state": "WI",
            "postal_code": "531282124",
            "telephone_number": "262-295-1213",
            "fax_number": "262-295-1221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 ELIZABETH LANE",
            "city": "GENOA CITY",
            "state": "WI",
            "postal_code": "531282124",
            "telephone_number": "262-295-1213",
            "fax_number": "262-295-1221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENEVA SURGICAL SUITES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-22",
        "last_updated": "2020-05-12",
        "certification_date": "2020-05-12",
        "status": "A",
        "authorized_official_last_name": "ROEKER",
        "authorized_official_first_name": "KRISTEN",
        "authorized_official_title_or_position": "BUSINESS ADMINISTRATOR",
        "authorized_official_telephone_number": "262-295-1216"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Burr Oak Manor, Inc.
• Albert Joseph Dietz Jr., MD
• Sharon Lee Ehrlich, LPN
• Jennifer Ann Frisby
• Lucia G Garrity, R.N.
• Genoa City Fyzical, LLC
• Genoa City Physical Therapy
• Michael J Hennigan, PTA
• Implantologie LLC
• Jason Kirkham, DC

• Ambulatory Surgical Clinic/Center in Genoa City, WI
• Providers in Genoa City, WI by specialty
• Ambulatory Surgical Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.