NPIMap

Organization Active NPI

Maple Medical SC

  • Physical Medicine & Rehabilitation Physician
  • Waukesha, WI
National Provider Identifier
1487152104
Registry record updated Jun 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
MAPLE MEDICAL SC
Practice address
2428 N Grandview Blvd Ste 102
Waukesha, WI 53188-6906
Phone
(877) 307-3226
Fax
(877) 307-3226
NPI assigned
Jan 28, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2021

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

Authorized official

Name
Harry Hostetler, MDNPI 1093775090
Title
Owner
Phone
(262) 875-5070

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QG0300X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Physical Medicine & Rehabilitation PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208100000X Primary
Adult Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LA2200X

Addresses

Primary practice location

2428 N Grandview Blvd Ste 102
Waukesha, WI 53188-6906

Mailing address

PO Box 474
Hartland, WI 53029-0474
Phone (877) 307-3226

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180328002607 WI Part B Supplier - Clinic/Group Practice 9032471248 Receives reassigned benefits from 139 practitioners
Practice locations: New Berlin, WI; Waukesha, WI

National Provider Directory

National Provider Directory

Locations

838 E Veterans Way
Mukwonago, WI 53149

Practitioners & affiliated clinicians

Practitioners 152

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 152

NPI Registry JSON

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

{
    "created_epoch": "1517097600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623628800000",
    "number": "1487152104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 474",
            "city": "HARTLAND",
            "state": "WI",
            "postal_code": "530290474",
            "telephone_number": "877-307-3226",
            "fax_number": "866-384-9486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2428 N GRANDVIEW BLVD STE 102",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531886906",
            "telephone_number": "877-307-3226",
            "fax_number": "877-307-3226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAPLE MEDICAL SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-28",
        "last_updated": "2021-06-14",
        "certification_date": "2021-06-14",
        "status": "A",
        "authorized_official_last_name": "HOSTETLER",
        "authorized_official_first_name": "HARRY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "262-875-5070",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waukesha, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.