NPIMap

Organization Active NPI

Hart Road Pathology SC

  • Clinical Pathology Physician
  • Beloit, WI
National Provider Identifier
1740459072
Registry record updated Feb 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Pathology PhysicianTaxonomy code 207ZC0006X
License
46411 Issued in WI
Legal business name
HART ROAD PATHOLOGY SC
Practice address
1969 W Hart Rd
Beloit, WI 53511-2230
Phone
(608) 364-5123
NPI assigned
Feb 20, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2008

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

Authorized official

Name
Mrs. Deborah JB Gustafson
Title
Manager Patient Accounts
Phone
(608) 364-5123

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Pathology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207ZC0006X 46411 WI Primary

Addresses

Primary practice location

1969 W Hart Rd
Beloit, WI 53511-2230

Mailing address

1969 W Hart Rd
Beloit, WI 53511-2230
Phone (608) 364-5123

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041006000211 WI Part B Supplier - Clinic/Group Practice 7113986100 Receives reassigned benefits from 3 practitioners
Practice locations: Beloit, WI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1203465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203465600000",
    "number": "1740459072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1969 W HART RD",
            "city": "BELOIT",
            "state": "WI",
            "postal_code": "535112230",
            "telephone_number": "608-364-5123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1969 W HART RD",
            "city": "BELOIT",
            "state": "WI",
            "postal_code": "535112230",
            "telephone_number": "608-364-5123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HART ROAD PATHOLOGY SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-20",
        "last_updated": "2008-02-20",
        "status": "A",
        "authorized_official_last_name": "GUSTAFSON",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "JB",
        "authorized_official_title_or_position": "MANAGER PATIENT ACCOUNTS",
        "authorized_official_telephone_number": "608-364-5123",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207ZC0006X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Clinical Pathology",
            "state": "WI",
            "license": "46411",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beloit, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2008; 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.