NPIMap

Organization Active NPI

Pivotal Health, Inc.

  • Family Medicine Physician
  • Middleton, WI
National Provider Identifier
1508465220
Registry record updated Nov 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PIVOTAL HEALTH, INC.
Practice address
3030 Laura LN Ste 130
Middleton, WI 53562-1872
Phone
(888) 688-4746
NPI assigned
Oct 23, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2021

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

Authorized official

Name
Mr. Salvatore Pier Braico
Title
Chief Executive Officer
Phone
(608) 213-8246

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

3030 Laura LN Ste 130
Middleton, WI 53562-1872

Mailing address

3030 Laura LN Ste 130
Middleton, WI 53562-1872
Phone (608) 213-8246

Other practice location 1

W134N5500 Campbell Dr
Menomonee Falls, WI 53051-7032
Phone (888) 688-4746

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL test

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210809002587 WI Part B Supplier - Clinic/Group Practice 5496159782 Receives reassigned benefits from 20 practitioners
Practice locations: Green Bay, WI; Holmen, WI; Menomonee Falls, WI; Middleton, WI; Oshkosh, WI

National Provider Directory

National Provider Directory

Locations

1812 Brackett Ave
Ste 9
Eau Claire, WI 54701

941 Ashwaubenon St
Green Bay, WI 54304

941 Ashwaubenon St
Unit Ae
Green Bay, WI 54304
Phone (888) 688-4746

1805 Granary St
Unit 12
Holmen, WI 54636
Phone (888) 688-4746

1805 Granary St
Holmen, WI 54636

W134N5500 Campbell Dr
Menomonee Falls, WI 53051
Phone (888) 688-4746

3030 Laura Ln
Ste 130
Middleton, WI 53562
Phone (888) 688-4746

3030 Laura Ln
Middleton, WI 53562
Phone (888) 688-4746

2755 Algoma Blvd
Oshkosh, WI 54901
Phone (888) 688-4746

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/23915/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1603411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636934400000",
    "number": "1508465220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3030 LAURA LN STE 130",
            "city": "MIDDLETON",
            "state": "WI",
            "postal_code": "535621872",
            "telephone_number": "608-213-8246",
            "fax_number": "608-960-7789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3030 LAURA LN STE 130",
            "city": "MIDDLETON",
            "state": "WI",
            "postal_code": "535621872",
            "telephone_number": "888-688-4746"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "W134N5500 Campbell Dr",
            "address_purpose": "LOCATION",
            "city": "Menomonee Falls",
            "state": "WI",
            "postal_code": "530517032",
            "country_code": "US",
            "telephone_number": "888-688-4746",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PIVOTAL HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-23",
        "last_updated": "2021-11-15",
        "certification_date": "2021-11-15",
        "status": "A",
        "authorized_official_last_name": "BRAICO",
        "authorized_official_first_name": "SALVATORE",
        "authorized_official_middle_name": "PIER",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "608-213-8246",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "test",
            "affiliation": "N",
            "address_1": "3030 Laura Ln Ste 130",
            "city": "Middleton",
            "state": "WI",
            "country_code": "US",
            "postal_code": "535621872",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Middleton, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 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.