NPIMap

Organization Active NPI

West Grove Clinic, SC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Wauwatosa, WI
National Provider Identifier
1518167477
Registry record updated Nov 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
WEST GROVE CLINIC, SC
Practice address
10012 W. Capitol Dr. #101
Wauwatosa, WI 53222-1300
Phone
(414) 810-4844
Fax
(414) 810-4845
NPI assigned
Jul 19, 2007
Last updated
Nov 12, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2024

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

Authorized official

Name
Selahattin S. Kurter, MDNPI 1164596615
Title
Executive Director
Phone
(414) 810-4844

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 2318 WI
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU Primary

Addresses

Primary practice location

10012 W. Capitol Dr. #101
Wauwatosa, WI 53222-1300

Mailing address

10012 W. Capitol Dr #101
Wauwatosa, WI 53222-1300
Phone (414) 810-4844

Other identifiers 1

IdentifierTypeStateIssuer
42229100MedicaidWI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050616000721 WI Part B Supplier - Clinic/Group Practice 2264476688 Receives reassigned benefits from 23 practitioners
Practice locations: Appleton, WI; Kenosha, WI; Milwaukee, WI; Oak Creek, WI

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
52D2025014West Grove Clinic, LLC10012 W Capitol Dr #101, Wauwatosa, WI 53222Certificate of waiverMay 30, 2027

National Provider Directory

National Provider Directory

Locations

17 Park Pl
Ste 400
Appleton, WI 54914
Phone (920) 209-1765

2545 Roosevelt Rd
Ste 105
Marinette, WI 54143
Phone (715) 701-4456

6419 S Howell Ave
Oak Creek, WI 53154
Phone (414) 304-5713

10012 W Capitol Dr
Wauwatosa, WI 53222
Phone (414) 810-4844

10012 W Capitol Dr
Ste 101
Wauwatosa, WI 53222
Phone (414) 810-4844

Practitioners & affiliated clinicians

Practitioners 76

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 76

NPI Registry JSON

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

{
    "created_epoch": "1184803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731369600000",
    "number": "1518167477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10012 W. CAPITOL DR #101",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532221300",
            "telephone_number": "414-810-4844",
            "fax_number": "414-810-4845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10012 W. CAPITOL DR. #101",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532221300",
            "telephone_number": "414-810-4844",
            "fax_number": "414-810-4845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST GROVE CLINIC, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-19",
        "last_updated": "2024-11-12",
        "status": "A",
        "authorized_official_last_name": "KURTER",
        "authorized_official_first_name": "SELAHATTIN",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "414-810-4844",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "WI",
            "license": "2318",
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42229100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wauwatosa, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.