Individual provider Active NPI

Eduardo Scholcoff, MD

  • Family Medicine Physician
  • Waukesha, WI
National Provider Identifier
1669457214
Registry record updated Jan 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
55192 Issued in WI
Practice address
210 NW Barstow St
Suite 201
Waukesha, WI 53188-3771
Phone
(262) 548-6903
Fax
(262) 548-3820
NPI assigned
Dec 7, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036092014 IL
Family Medicine Physician 207Q00000X 55192 WI Primary

Addresses

Primary practice location

210 NW Barstow St
Suite 201
Waukesha, WI 53188-3771

Mailing address

10000 W Innovation Dr
Suite 300
Milwaukee, WI 53226-4837
Phone (414) 456-5006

Other identifiers 3

IdentifierTypeStateIssuer
036092014MedicaidIL
036092014OtherILSTATE LICENSE
1669457214MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036092014ILMDFamily Medicine Physician
55192WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Medical College of Wisconsin, Inc. Family Medicine Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1133913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1296172800000",
    "number": "1669457214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10000 W INNOVATION DR",
            "address_2": "SUITE 300",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532264837",
            "telephone_number": "414-456-5006",
            "fax_number": "414-456-6259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 NW BARSTOW ST",
            "address_2": "SUITE 201",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531883771",
            "telephone_number": "262-548-6903",
            "fax_number": "262-548-3820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHOLCOFF",
        "first_name": "EDUARDO",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-07",
        "last_updated": "2011-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036092014",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "55192",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036092014",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "036092014",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1669457214",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waukesha, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2011; 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.