NPIMap

Organization Active NPI

Azh Vascular Center Mke SC

  • Vascular & Interventional Radiology Physician
  • Milwaukee, WI
National Provider Identifier
1508312570
Registry record updated Jul 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
Legal business name
AZH VASCULAR CENTER MKE SC
Practice address
2500 W Layton Ave
Suite 40
Milwaukee, WI 53221-5420
Phone
(262) 577-0250
Fax
(262) 577-0251
NPI assigned
Aug 30, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2021

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

Authorized official

Name
Valerie Wagner
Title
Practice Manager
Phone
(262) 577-0250

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Undersea and Hyperbaric Medicine (Emergency Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207PE0005X
Vascular & Interventional Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0204X Primary
Vascular Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0129X
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208G00000X

Addresses

Primary practice location

2500 W Layton Ave
Suite 40
Milwaukee, WI 53221-5420

Mailing address

2500 W Layton Ave
Suite 40
Milwaukee, WI 53221-5420
Phone (262) 577-0250

Other names 1

  • AZH Vascular Center MKE LLC Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161121000201 WI Part B Supplier - Clinic/Group Practice 3072892710 Receives reassigned benefits from 3 practitioners
Practice locations: Milwaukee, WI; Sheboygan, WI

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/25552/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 11

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": "1472515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625788800000",
    "number": "1508312570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 W LAYTON AVE",
            "address_2": "SUITE 40",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532215420",
            "telephone_number": "262-577-0250",
            "fax_number": "262-577-0251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 W LAYTON AVE",
            "address_2": "SUITE 40",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532215420",
            "telephone_number": "262-577-0250",
            "fax_number": "262-577-0251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AZH VASCULAR CENTER MKE SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-30",
        "last_updated": "2021-07-09",
        "certification_date": "2021-07-09",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "VALERIE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "262-577-0250"
    },
    "taxonomies": [
        {
            "code": "207PE0005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine, Undersea and Hyperbaric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AZH Vascular Center MKE LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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 Jul 9, 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.