NPIMap

Organization Active NPI

Comprehensive Clinical and Consulting Services, Inc

  • Psychologist
  • Milwaukee, WI
National Provider Identifier
1487830790
Registry record updated Jan 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
1233 Issued in WI
Legal business name
COMPREHENSIVE CLINICAL AND CONSULTING SERVICES, INC
Practice address
7161 N Port Washington Rd
Suite 102
Milwaukee, WI 53217-3877
Phone
(414) 352-7682
Fax
(414) 352-7625
NPI assigned
Jan 16, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2008

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

Authorized official

Name
Dr. Itzhak Matusiak, PHDNPI 1033276282
Title
Clinic Director
Phone
(414) 352-7682

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103T00000X 1233 WI Primary

Addresses

Primary practice location

7161 N Port Washington Rd
Suite 102
Milwaukee, WI 53217-3877

Mailing address

7161 N Port Washington Rd
Suite 102
Milwaukee, WI 53217-3877
Phone (414) 352-7682

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041129000434 WI Part B Supplier - Clinic/Group Practice 2466417746 Receives reassigned benefits from 1 practitioner
Practice locations: Milwaukee, WI

National Provider Directory

National Provider Directory

Locations

7161 N Port Washington Rd
Ste W
Glendale, WI 53217

7161 N Port Washington Rd
Glendale, WI 53217
Phone (414) 247-1470

7161 N Port Washington Rd
Ste 102
Glendale, WI 53217
Phone (414) 352-7682

Practitioners & affiliated clinicians

Practitioners 8

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

NPI Registry JSON

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

{
    "created_epoch": "1200441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200441600000",
    "number": "1487830790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7161 N PORT WASHINGTON RD",
            "address_2": "SUITE 102",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532173877",
            "telephone_number": "414-352-7682",
            "fax_number": "414-352-7625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7161 N PORT WASHINGTON RD",
            "address_2": "SUITE 102",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532173877",
            "telephone_number": "414-352-7682",
            "fax_number": "414-352-7625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPREHENSIVE CLINICAL AND CONSULTING SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-16",
        "last_updated": "2008-01-16",
        "status": "A",
        "authorized_official_last_name": "MATUSIAK",
        "authorized_official_first_name": "ITZHAK",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "414-352-7682",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "WI",
            "license": "1233",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2008; 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.