NPIMap

Organization Active NPI

Radiology Waukesha S.C.

  • Diagnostic Radiology Physician
  • Waukesha, WI
National Provider Identifier
1730175258
Registry record updated Aug 22, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
RADIOLOGY WAUKESHA S.C.
Practice address
725 American Ave
Waukesha, WI 53188-5031
Phone
(262) 928-2400
Fax
(262) 928-7621
NPI assigned
Sep 20, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2007

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

Authorized official

Name
Dr. Jefffrey Matthew Fete, M.D.
Title
President
Phone
(262) 928-2400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

725 American Ave
Waukesha, WI 53188-5031

Mailing address

PO Box 1790
Brookfield, WI 53008-1790
Phone (262) 641-9411

Other identifiers 1

IdentifierTypeStateIssuer
32727700MedicaidWI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040428000089 WI Part B Supplier - Clinic/Group Practice 3274520648 Receives reassigned benefits from 35 practitioners
Practice locations: Waukesha, WI; Watertown, WI; Oconomowoc, WI; Mukwonago, WI

National Provider Directory

National Provider Directory

Locations

725 American Ave
Ste 100
Waukesha, WI 53188

1011 Spring City Dr
Waukesha, WI 53186
Phone (262) 925-0370

2421 N Mayfair Rd
Wauwatosa, WI 53226

Practitioners & affiliated clinicians

Practitioners 40

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 40

NPI Registry JSON

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

{
    "created_epoch": "1127174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187740800000",
    "number": "1730175258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1790",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530081790",
            "telephone_number": "262-641-9411",
            "fax_number": "262-641-6893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 AMERICAN AVE",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531885031",
            "telephone_number": "262-928-2400",
            "fax_number": "262-928-7621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RADIOLOGY WAUKESHA S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-20",
        "last_updated": "2007-08-22",
        "status": "A",
        "authorized_official_last_name": "FETE",
        "authorized_official_first_name": "JEFFFREY",
        "authorized_official_middle_name": "MATTHEW",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "262-928-2400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32727700",
            "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 Aug 22, 2007; 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.