NPIMap

Individual provider Active NPI

Charles Jay Waisbren, MD

  • Internal Medicine Physician
  • Wauwatosa, WI
National Provider Identifier
1750481206
Registry record updated May 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
25111 Issued in WI
Practice address
201 N Mayfair Rd
Suite 510
Wauwatosa, WI 53226-4216
Phone
(414) 771-5900
Fax
(414) 771-4908
NPI assigned
Sep 25, 2006
Last updated
May 10, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 10, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 25111 WI Primary

Addresses

Primary practice location

201 N Mayfair Rd
Suite 510
Wauwatosa, WI 53226-4216

Mailing address

201 N Mayfair Rd
Ste 510
Wauwatosa, WI 53226-4216
Phone (414) 771-5900

Other identifiers 1

IdentifierTypeStateIssuer
305641000MedicaidWI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070314000505 WI Practitioner - Internal Medicine 9133222060 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
JS Weill Medical College, Cornell University, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

201 N Mayfair Rd
Suite 510
Wauwatosa, WI 53226-4216
Phone (414) 771-5900

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25111WIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Partners in Health Collective SC Internal Medicine Current Accepting new patients
Charles J. Waisbren MD S.C. Internal Medicine CurrentSince Jan 29, 2007 Accepting new patients
Burton a Waisbren MD SC Internal Medicine Current Accepting new patients
Frances Mahon Deaconess Hospital Past Accepting new patients

Locations

2500 W Layton Ave
Ste 130
Milwaukee, WI 53221
Phone (414) 281-1944

201 N Mayfair Rd
Wauwatosa, WI 53226
Phone (414) 259-7200

201 N Mayfair Rd
Ste 510
Wauwatosa, WI 53226
Phone (414) 475-5742

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462838400000",
    "number": "1750481206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 N MAYFAIR RD",
            "address_2": "STE 510",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532264216",
            "telephone_number": "414-771-5900",
            "fax_number": "414-771-4908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 N MAYFAIR RD",
            "address_2": "SUITE 510",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532264216",
            "telephone_number": "414-771-5900",
            "fax_number": "414-771-4908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAISBREN",
        "first_name": "CHARLES",
        "middle_name": "JAY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-25",
        "last_updated": "2016-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "25111",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "305641000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wauwatosa, WI

Sources for this page

Verify at the official NPI Registry.