NPIMap

Organization Active NPI

Midwest Sports and Interventional Spine SC

  • Interventional Pain Medicine Physician
  • Lake Geneva, WI
National Provider Identifier
1740154947
Registry record updated Oct 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
Legal business name
MIDWEST SPORTS AND INTERVENTIONAL SPINE SC
Practice address
850 Geneva Pkwy N Ste 100
Lake Geneva, WI 53147-4562
Phone
(262) 299-6199
Fax
(262) 293-6953
NPI assigned
Oct 1, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2025

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

Authorized official

Name
Cyril N Philip, MDNPI 1578713343
Title
Owner
Phone
(847) 343-0711

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0014X Primary

Addresses

Primary practice location

850 Geneva Pkwy N Ste 100
Lake Geneva, WI 53147-4562

Mailing address

2070 Green Bay Rd Ste 163
Highland Park, IL 60035-2412
Phone (262) 299-6199

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251219003999 WI DME Supplier - Multi-Specialty - Physician 8325447170 Practice locations: Lake Geneva, WI

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Midwest Sports and Interventional Spine SC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

10500 W Loomis Rd
Ste 130
Franklin, WI 53132
Phone (414) 488-0678

4824 Green Bay Rd
Kenosha, WI 53144
Phone (262) 299-6199

850 Geneva Pkwy N
Ste 100
Lake Geneva, WI 53147
Phone (262) 299-6199

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1759276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759276800000",
    "number": "1740154947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2070 GREEN BAY RD STE 163",
            "city": "HIGHLAND PARK",
            "state": "IL",
            "postal_code": "600352412",
            "telephone_number": "262-299-6199",
            "fax_number": "262-293-6953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 GENEVA PKWY N STE 100",
            "city": "LAKE GENEVA",
            "state": "WI",
            "postal_code": "531474562",
            "telephone_number": "262-299-6199",
            "fax_number": "262-293-6953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST SPORTS AND INTERVENTIONAL SPINE SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-10-01",
        "last_updated": "2025-10-01",
        "certification_date": "2025-10-01",
        "status": "A",
        "authorized_official_last_name": "PHILIP",
        "authorized_official_first_name": "CYRIL",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "847-343-0711",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Geneva, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2025; 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.