NPIMap

Organization Active NPI

Ganesha Institute of Neurology and Psychiatry SC

  • Neurology Physician
  • Kenosha, WI
National Provider Identifier
1619731320
Registry record updated Jan 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
Legal business name
GANESHA INSTITUTE OF NEUROLOGY AND PSYCHIATRY SC
Practice address
4600 Green Bay Rd
Kenosha, WI 53144-1719
Phone
(262) 286-1860
NPI assigned
Feb 13, 2024
Last updated
Jan 17, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
GANESHA INSTITUTE OF NEUROLOGY AND PSYCHIATRY SCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 17, 2025

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

Authorized official

Name
Lori A Smith
Title
Office Manager
Phone
(847) 816-6441

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NU
Clinical Social Worker 1041C0700X NU
Neurology Physician 2084N0400X NU Primary
Psychiatry Physician 2084P0800X NU
Vascular Neurology Physician 2084V0102X NU

Addresses

Primary practice location

4600 Green Bay Rd
Kenosha, WI 53144-1719

Mailing address

PO Box 14545
Belfast, ME 04915-4038
Phone (847) 816-6335

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221214000103 WI Part B Supplier - Clinic/Group Practice 0042432296 Receives reassigned benefits from 23 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kenosha, WI

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Ganesha Institute of Neurology and Psychiatry SC

Locations

9327 N 3rd St
Ste 200
Phoenix, AZ 85020
Phone (520) 595-5500

30 Tower Ct
Ste C
Gurnee, IL 60031
Phone (847) 599-0715

4600 Green Bay Rd
Kenosha, WI 53144
Phone (847) 816-6335

Practitioners & affiliated clinicians

Practitioners 44

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 44

NPI Registry JSON

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

{
    "created_epoch": "1707782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737072000000",
    "number": "1619731320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14545",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049154038",
            "telephone_number": "847-816-6335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4600 GREEN BAY RD",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531441719",
            "telephone_number": "262-286-1860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GANESHA INSTITUTE OF NEUROLOGY AND PSYCHIATRY SC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GANESHA INSTITUTE OF NEUROLOGY AND PSYCHIATRY SC",
        "enumeration_date": "2024-02-13",
        "last_updated": "2025-01-17",
        "certification_date": "2025-01-17",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "LORI",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "847-816-6441"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084V0102X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Vascular Neurology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kenosha, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2025; 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.