Individual provider Active NPI

Emad Botros, MD

  • Pulmonary Disease Physician
  • Milwaukee, WI
National Provider Identifier
1689621864
Registry record updated Jun 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
42125-020 Issued in WI
Practice address
2311 N Prospect Ave
Milwaukee, WI 53211-4445
Phone
(414) 319-3000
NPI assigned
May 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X 42125-020 WI Primary

Addresses

Primary practice location

2311 N Prospect Ave
Milwaukee, WI 53211-4445

Mailing address

4425 N Port Washington Rd
Attn: Csmcp Clinic Credentialing
Glendale, WI 53212-1082
Phone (414) 319-3000

Other identifiers 2

IdentifierTypeStateIssuer
P00150206OtherWIRAILROAD MEDICARE
33325300MedicaidWI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041026000430 WI Practitioner - Pulmonary Disease 3577524446 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
42125-020WIMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Columbia St. Mary's Hospital Milwaukee, Inc CurrentSince Aug 15, 2009 Accepting new patients
Columbia St. Mary's Hospital Milwaukee Inc CurrentSince Aug 15, 2009 Accepting new patients
Emad Botros, M.D., S.C. Pulmonary Disease PastSince Sep 14, 2004 Accepting new patients
Dr. Marvin Lauwasser, SC Past Accepting new patients

Locations

N112W15415 Mequon Rd
Germantown, WI 53022
Phone (262) 250-7800

6900 N Port Washington Rd
Glendale, WI 53217
Phone (414) 270-8100

3237 S 16th St
Milwaukee, WI 53215
Phone (414) 647-5000

2311 N Prospect Ave
Milwaukee, WI 53211
Phone (414) 319-3000

13111 N Port Washington Rd
Thiensville, WI 53097
Phone (262) 243-7300

801 S 70th St
West Allis, WI 53214
Phone (414) 773-6600

Organizations & group practices 4

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": "1149033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1338854400000",
    "number": "1689621864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4425 N PORT WASHINGTON RD",
            "address_2": "ATTN: CSMCP CLINIC CREDENTIALING",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532121082",
            "telephone_number": "414-319-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2311 N PROSPECT AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532114445",
            "telephone_number": "414-319-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOTROS",
        "first_name": "EMAD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-31",
        "last_updated": "2012-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "WI",
            "license": "42125-020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00150206",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33325300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.