NPIMap

Organization Active NPI

Wisconsin Institute of Urology SC

  • Urology Physician
  • Neenah, WI
National Provider Identifier
1578872628
Registry record updated May 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
WISCONSIN INSTITUTE OF UROLOGY SC
Practice address
1265 W American Dr Ste 100
Neenah, WI 54956
Phone
(920) 722-7747
Fax
(920) 993-5002
NPI assigned
Oct 6, 2010
Last updated
May 12, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2021

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

Authorized official

Name
Omar Atassi, MDNPI 1154380046
Title
President
Phone
(920) 722-7747

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
Urology Physician 208800000X WI Primary

Addresses

Primary practice location

1265 W American Dr Ste 100
Neenah, WI 54956

Mailing address

1265 W American Dr Ste 100
Neenah, WI 54956-1405
Phone (920) 722-7747

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110307000045 WI Part B Supplier - Clinic/Group Practice 6608058078 Receives reassigned benefits from 22 practitioners
Practice locations: Shawano, WI; Waupaca, WI; Ripon, WI; Oshkosh, WI; New London, WI; Neenah, WI; Fond Du Lac, WI; Appleton, WI

National Provider Directory

National Provider Directory

Locations

100 Theda Clark Medical Plz
Neenah, WI 54956
Phone (920) 722-7747

1265 West American Dr
#100
Neenah, WI 54956
Phone (920) 722-7747

Practitioners & affiliated clinicians

Practitioners 23

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 23

NPI Registry JSON

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

{
    "created_epoch": "1286323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620777600000",
    "number": "1578872628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1265 W AMERICAN DR STE 100",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549561405",
            "telephone_number": "920-722-7747",
            "fax_number": "920-993-5002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1265 W AMERICAN DR STE 100",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "54956",
            "telephone_number": "920-722-7747",
            "fax_number": "920-993-5002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISCONSIN INSTITUTE OF UROLOGY SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-06",
        "last_updated": "2021-05-12",
        "certification_date": "2021-05-12",
        "status": "A",
        "authorized_official_last_name": "ATASSI",
        "authorized_official_first_name": "OMAR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "920-722-7747",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Neenah, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 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.