NPIMap

Organization Active NPI

Emergency Medicine of Racine SC

  • Emergency Medicine Physician
  • Mount Pleasant, WI
National Provider Identifier
1598102717
Registry record updated Jun 3, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
EMERGENCY MEDICINE OF RACINE SC
Practice address
3807 Spring St
Mount Pleasant, WI 53405-1667
Phone
(262) 687-8150
NPI assigned
May 29, 2013
Last updated
Jun 3, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2013

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

Authorized official

Name
Stephen G Holtzclaw, MD
Title
President
Phone
(954) 377-2927

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X Primary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X

Addresses

Primary practice location

3807 Spring St
Mount Pleasant, WI 53405-1667

Mailing address

307 S Evergreen Ave
Woodbury, NJ 08096-2739
Phone (856) 686-4306

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130923000307 WI Part B Supplier - Clinic/Group Practice 8527202142 Receives reassigned benefits from 17 practitioners
Practice locations: Durand, WI; Racine, WI

National Provider Directory

National Provider Directory

Locations

5000 Hopyard Rd
Ste 410
Pleasanton, CA 94588

1220 3rd Ave W
Ste 410
Durand, WI 54736

Practitioners & affiliated clinicians

Practitioners 22

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 22

NPI Registry JSON

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

{
    "created_epoch": "1369785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370217600000",
    "number": "1598102717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 S EVERGREEN AVE",
            "city": "WOODBURY",
            "state": "NJ",
            "postal_code": "080962739",
            "telephone_number": "856-686-4306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3807 SPRING ST",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "534051667",
            "telephone_number": "262-687-8150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMERGENCY MEDICINE OF RACINE SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-29",
        "last_updated": "2013-06-03",
        "status": "A",
        "authorized_official_last_name": "HOLTZCLAW",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "954-377-2927",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Pleasant, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2013; 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.