NPIMap

Individual provider Active NPI

Ganesh N Pulla, M.D

  • Nephrology Physician
  • Kenosha, WI
National Provider Identifier
1679620918
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
40695 Issued in WI
Practice address
6125 Green Bay Rd
100
Kenosha, WI 53142-2928
Phone
(262) 564-8636
Fax
(262) 564-8637
NPI assigned
Jan 5, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 40695 WI Primary

Addresses

Primary practice location

6125 Green Bay Rd
100
Kenosha, WI 53142-2928

Mailing address

6125 Green Bay Rd
100
Kenosha, WI 53142-2928
Phone (262) 564-8636

Other identifiers 1

IdentifierTypeStateIssuer
21279800MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040920000113 WI Practitioner - NephrologyPractitioner - Internal Medicine 0345218384 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Independent Physicians of Wisconsin LLCGroup PAC ID 3274842034, 42 clinicians

Practice addresses (Care Compare)

6125 Green Bay Rd
Suite 100
Kenosha, WI 53142-2942
Phone (262) 564-8636

6125 Greenbay Rd
Suite 100
Kenosha, WI 53142-2928
Phone (262) 564-8636

Hospital & facility affiliations

  • Fresenius Medical Care Midwest Kenosha Dialysis facility, Kenosha, WI, CCN 522564
  • Aurora Medical Center Kenosha Hospital, Kenosha, WI, CCN 520189
  • Aurora St Lukes Medical Center Hospital, Milwaukee, WI, CCN 520138
  • Froedtert South Inc. Hospital, Kenosha, WI, CCN 520021

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
40695WIMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kidney Replacement Therapies, SC Current Accepting new patients
Kidney Care Home SC Nephrology Current Accepting new patients
Independent Physicians of Wisconsin, LLC CurrentSince Mar 1, 2024 Accepting new patients
Independent Physicians of Wisconsin, LLC CurrentSince Mar 1, 2024 Accepting new patients

Locations

6125 Green Bay Rd
Ste 100
Kenosha, WI 53142
Phone (262) 564-8636

5434 W Capitol Dr
Ste 3
Milwaukee, WI 53216
Phone (414) 217-1229

2500 W Layton Ave
Ste 10
Milwaukee, WI 53221
Phone (414) 281-9665

Interoperability endpoints

  • Direct secure messaging: ganesh.pulla.1@18758.direct.athenahealth.com

Organizations & group practices 5

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1679620918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6125 GREEN BAY RD",
            "address_2": "100",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531422928",
            "telephone_number": "262-564-8636",
            "fax_number": "262-564-8637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6125 GREEN BAY RD",
            "address_2": "100",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531422928",
            "telephone_number": "262-564-8636",
            "fax_number": "262-564-8637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PULLA",
        "first_name": "GANESH",
        "middle_name": "N",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "WI",
            "license": "40695",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "21279800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kenosha, WI

Sources for this page

Verify at the official NPI Registry.