NPIMap

Organization Active NPI

Premise Health of Connecticut Medical, P.C.

Doing business as Harley Davidson Health Center- Pilgrim Road

  • Occupational Medicine Clinic/Center
  • Menomonee Falls, WI
National Provider Identifier
1770868135
Registry record updated Aug 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Medicine Clinic/CenterTaxonomy code 261QX0100X
Legal business name
PREMISE HEALTH OF CONNECTICUT MEDICAL, P.C.
Doing business as
Harley Davidson Health Center- Pilgrim Road
Practice address
W156 N 9000 Rilgrim Rd
Menomonee Falls, WI 53051
Phone
(262) 502-8752
Fax
(262) 502-8756
NPI assigned
Oct 18, 2011
Last updated
Aug 15, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2022

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

Authorized official

Name
Jon Leizman, M.D.
Title
President
Phone
(216) 479-9063

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X
Urgent Care Clinic/Center 261QU0200X
Occupational Medicine Clinic/Center 261QX0100X Primary

Addresses

Primary practice location

W156 N 9000 Rilgrim Rd
Menomonee Falls, WI 53051

Mailing address

16906 Collection Center Dr
Chicago, IL 60693-0169
Phone (262) 502-8752

Other names 1

  • Harley Davidson Health Center- Pilgrim Road Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Premise Health of Connecticut Medical PC21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

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

View all 20

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1318896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660521600000",
    "number": "1770868135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16906 COLLECTION CENTER DR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606930169",
            "telephone_number": "262-502-8752",
            "fax_number": "262-502-8756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W156 N 9000 RILGRIM RD",
            "city": "MENOMONEE FALLS",
            "state": "WI",
            "postal_code": "53051",
            "telephone_number": "262-502-8752",
            "fax_number": "262-502-8756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMISE HEALTH OF CONNECTICUT MEDICAL, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-18",
        "last_updated": "2022-08-15",
        "certification_date": "2022-08-15",
        "status": "A",
        "authorized_official_last_name": "LEIZMAN",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "216-479-9063",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QX0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Occupational Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Harley Davidson Health Center- Pilgrim Road",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Harley Davidson Health Center- Pilgrim Road",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Menomonee Falls, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.