St Nicholas Health Institute SC

Primary specialty

Orthopedic ChiropractorTaxonomy code 111NX0800X

License

3517-012 Issued in WI

Legal business name

ST NICHOLAS HEALTH INSTITUTE SC

Practice address

1033 N Mayfair Rd
Suite 303
Wauwatosa, WI 53226-3442

Phone

(414) 778-1455

Fax

(414) 810-4052

NPI assigned

Feb 16, 2009

Last updated

Sep 2, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Bob Gountis, D.C.NPI 1477607612

Title

President

Phone

(414) 778-1455

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 1

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.

• Bob Matthew Gountis, D.C.

  • Chiropractor
  • Wauwatosa, WI
  • NPI 1477607612
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1234742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1283385600000",
    "number": "1689813545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1033 N MAYFAIR RD",
            "address_2": "SUITE 303",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532263442",
            "telephone_number": "414-778-1455",
            "fax_number": "414-778-1865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1033 N MAYFAIR RD",
            "address_2": "SUITE 303",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532263442",
            "telephone_number": "414-778-1455",
            "fax_number": "414-810-4052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST NICHOLAS HEALTH INSTITUTE SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-16",
        "last_updated": "2010-09-02",
        "status": "A",
        "authorized_official_last_name": "GOUNTIS",
        "authorized_official_first_name": "BOB",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "414-778-1455",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111NX0800X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Orthopedic",
            "state": "WI",
            "license": "3517-012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Orthopedic Chiropractor in Wauwatosa, WI
• Providers in Wauwatosa, WI by specialty
• Orthopedic Chiropractor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2010; 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.