NPIMap

Individual provider Active NPI

Loganathan Elangovan, MD

  • Nephrology Physician
  • Waukesha, WI
National Provider Identifier
1477572881
Registry record updated Dec 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
40898-020 Issued in WI
Practice address
1260 Sentry Dr Ste 140
Waukesha, WI 53186-5990
Phone
(262) 524-1024
Fax
(262) 524-8767
NPI assigned
Jul 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 40898-020 WI Primary

Addresses

Primary practice location

1260 Sentry Dr Ste 140
Waukesha, WI 53186-5990

Mailing address

1260 Sentry Dr Ste 140
Waukesha, WI 53186-5990
Phone (262) 524-1024

Other identifiers 1

IdentifierTypeStateIssuer
32616600MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050510000162 WI Practitioner - NephrologyPractitioner - Internal Medicine 3577503564 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Nephrology Associates SCGroup PAC ID 7416841663, 8 clinicians

Practice addresses (Care Compare)

1260 Sentry Dr
Suite 140
Waukesha, WI 53186-5990
Phone 2625241024300

Hospital & facility affiliations

  • DaVita Fort Atkinson Dialysis Dialysis facility, Fort Atkinson, WI, CCN 522533
  • DaVita Spring City Dialysis Dialysis facility, Waukesha, WI, CCN 522535
  • DaVita Janesville Dialysis Dialysis facility, Janesville, WI, CCN 522503
  • Fresenius Medical Care Midwest Waukesha Dialysis facility, Waukesha, WI, CCN 522581
  • Waukesha Memorial Hospital Hospital, Waukesha, WI, CCN 520008
  • Oconomowoc Memorial Hospital Hospital, Oconomowoc, WI, CCN 520062
  • Fort Memorial Hospital Hospital, Fort Atkinson, WI, CCN 520071
  • Watertown Memorial Hospital Hospital, Watertown, WI, CCN 520116
  • Aspirus Wausau Hospital Hospital, Wausau, WI, CCN 520030
  • Pam Health Rehabilitation Hospital of Wausau Inpatient rehabilitation facility, Wausau, WI, CCN 523034
  • Rehabilitation Hospital of Wisconsin Inpatient rehabilitation facility, Waukesha, WI, CCN 523027

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
40898-020WIMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Nephrology Associates SC CurrentSince Oct 16, 2000 Accepting new patients
Nephrology Associates SC CurrentSince Oct 16, 2000 Accepting new patients
Prohealth Medical Group Inc Past Accepting new patients

Locations

2301 Sun Valley Dr
Ste 200
Delafield, WI 53018
Phone (262) 646-4162

611 Sherman Ave E
Fort Atkinson, WI 53538
Phone (920) 563-6667

1185 Corporate Center Dr
Ste 175
Oconomowoc, WI 53066
Phone (262) 928-6236

1260 Sentry Dr
Ste 140
Waukesha, WI 53186
Phone 2625241024300

1260 Sentry Dr
Waukesha, WI 53186
Phone (262) 446-5100

1111 Delafield St
Ste 327
Waukesha, WI 53188
Phone (262) 239-7070

Interoperability endpoints

  • Direct secure messaging: lelangovan10858@direct.phci.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 21

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608595200000",
    "number": "1477572881",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1260 SENTRY DR STE 140",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531865990",
            "telephone_number": "262-524-1024",
            "fax_number": "262-524-8767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1260 SENTRY DR STE 140",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531865990",
            "telephone_number": "262-524-1024",
            "fax_number": "262-524-8767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELANGOVAN",
        "first_name": "LOGANATHAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-18",
        "last_updated": "2020-12-22",
        "certification_date": "2020-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "WI",
            "license": "40898-020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32616600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waukesha, WI

Sources for this page

Verify at the official NPI Registry.