NPIMap

Organization Active NPI

Mark B. Smuckler MD LTD

  • Adult Mental Health Clinic/Center
  • Milwaukee, WI
National Provider Identifier
1528344819
Registry record updated Oct 31, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
License
16139 Issued in WI
Legal business name
MARK B. SMUCKLER MD LTD
Practice address
155 E Silver Spring Dr
203
Milwaukee, WI 53217-4704
Phone
(414) 332-2450
Fax
(414) 332-1390
NPI assigned
Oct 31, 2011
Last updated
Oct 31, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
MARK B. SMUCKLER MDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 31, 2011

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

Authorized official

Name
Dr. Mark B Smuckler, M.D.NPI 1518042183
Title
President
Phone
(414) 332-2450

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X 16139 WI Primary
Adolescent and Children Mental Health Clinic/Center 261QM0855X 16139 WI

Addresses

Primary practice location

155 E Silver Spring Dr
203
Milwaukee, WI 53217-4704

Mailing address

155 E Silver Spring Dr
203
Milwaukee, WI 53217-4704
Phone (414) 332-2450

Other identifiers 1

IdentifierTypeStateIssuer
30954800MedicaidWI

National Provider Directory

National Provider Directory
Part of
Mark B Smuckler MD LTD

Locations

155 E Silver Spring Dr
Ste 203
Milwaukee, WI 53217
Phone (414) 332-2450

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1320019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320019200000",
    "number": "1528344819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 E SILVER SPRING DR",
            "address_2": "203",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532174704",
            "telephone_number": "414-332-2450",
            "fax_number": "414-332-1390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 E SILVER SPRING DR",
            "address_2": "203",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532174704",
            "telephone_number": "414-332-2450",
            "fax_number": "414-332-1390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK B. SMUCKLER MD LTD",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARK B. SMUCKLER MD",
        "enumeration_date": "2011-10-31",
        "last_updated": "2011-10-31",
        "status": "A",
        "authorized_official_last_name": "SMUCKLER",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "414-332-2450",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "WI",
            "license": "16139",
            "primary": true
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "WI",
            "license": "16139",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30954800",
            "state": "WI"
        }
    ],
    "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 Oct 31, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.