Southeast Wisconsin Surgery Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

SOUTHEAST WISCONSIN SURGERY CENTER LLC

Practice address

3801 Washington Ave
Racine, WI 53405-2853

Phone

(414) 949-1938

NPI assigned

Apr 21, 2022

Organization subpart

No

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

Authorized official

Name

Dr. Chelsie Lisle, CRNANPI 1720634496

Title

Co-Owner

Phone

(402) 631-8892

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Ambulatory surgical center certification: CCN 52C0001155

Legal name

Southeast Wisconsin Surgery Center

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Nov 26, 2024

Last certification

Nov 26, 2024

Ownership / control type

Proprietary

Facility address

3801 Washington Ave.
Racine, WI 53405

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Chelsie Nicole Lisle, CRNA

  • Certified Registered Nurse Anesthetist
  • Mount Pleasant, WI
  • NPI 1720634496
  NPD (past) Authorized official

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

{
    "created_epoch": "1650499200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693180800000",
    "number": "1619611142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3801 WASHINGTON AVE",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534052853",
            "telephone_number": "402-631-8892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3801 WASHINGTON AVE",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534052853",
            "telephone_number": "414-949-1938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST WISCONSIN SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-21",
        "last_updated": "2023-08-28",
        "certification_date": "2023-08-28",
        "status": "A",
        "authorized_official_last_name": "LISLE",
        "authorized_official_first_name": "CHELSIE",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "402-631-8892",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1043820442",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1447319496",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "records@toothtownsbd.com",
            "affiliation": "Y",
            "endpointDescription": "email",
            "affiliationName": "Racine Tooth Town Dentistry for Kids",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "3801 Washington Ave",
            "city": "Racine",
            "state": "WI",
            "country_code": "US",
            "postal_code": "534052853",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Nathan D Sockrider, D.P.M.
• Maximillian Joseph Soldenwagner, OD
• Andrew Ira Solomon, DC
• Southeast Anesthesiology
• Southeast Wisconsin Hearing, LLC
• Southwest Dental Group, S.C.
• Southwest Family Dental Care LLC
• Kristine Marie Sova, PT
• Jennifer Spatafora, PHARMD
• Roger Theodore Spear, PHARMD

• Ambulatory Surgical Clinic/Center in Racine, WI
• Providers in Racine, WI by specialty
• Ambulatory Surgical Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.