Kettle Moraine Anesthesiology Inc

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

Legal business name

KETTLE MORAINE ANESTHESIOLOGY INC

Practice address

3200 Pleasant Valley Rd
West Bend, WI 53095-9274

Phone

(262) 334-5533

NPI assigned

Jun 19, 2006

Last updated

Jan 11, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jim Browne

Title

Clinic Administrator

Phone

(262) 334-5533

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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.

• Gregory G Blommel

  • Internal Medicine Physician
  • West Bend, WI
  • NPI 1184704546
  NPD (past)

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

{
    "created_epoch": "1150675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1263168000000",
    "number": "1598700817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 E WASHINGTON ST",
            "address_2": "P O BOX 8031",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549115490",
            "telephone_number": "866-313-0337",
            "fax_number": "920-739-0124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 PLEASANT VALLEY RD",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530959274",
            "telephone_number": "262-334-5533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KETTLE MORAINE ANESTHESIOLOGY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-19",
        "last_updated": "2010-01-11",
        "status": "A",
        "authorized_official_last_name": "BROWNE",
        "authorized_official_first_name": "JIM",
        "authorized_official_title_or_position": "CLINIC ADMINISTRATOR",
        "authorized_official_telephone_number": "262-334-5533"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "21261200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erin Kelley
• Kelly Darmody, LLC (Antidote Health Co)
• Michelle Kelly, OTR
• Kathryn M Kempf, MSW, APSW, LCSW-IT
• Mary Kempf, R.N.
• Kettle Moraine Chiropractic Clinic SC
• Kettle Moraine Counseling LLC (Kettle Moraine Counseling)
• Kettle Moraine YMCA, Inc. Young Men's Christian Association
• Patricia R Keuck, SOCIAL WORKER
• Raman Khanna, M.D.

• Anesthesiology Physician in West Bend, WI
• Providers in West Bend, WI by specialty
• Anesthesiology Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2010; 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.