NPIMap

Organization Active NPI

Neurotech, LLC

Doing business as Neurotech Indiana

  • Physiological Laboratory
  • Indianapolis, IN
National Provider Identifier
1790199859
Registry record updated Apr 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physiological LaboratoryTaxonomy code 293D00000X
Legal business name
NEUROTECH, LLC
Doing business as
Neurotech Indiana
Practice address
941 E 86TH St Ste 107
Indianapolis, IN 46240-1842
Phone
(262) 875-6611
NPI assigned
Jun 17, 2014
Last updated
Apr 23, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
NEUROTECH, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 23, 2021

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

Authorized official

Name
Kristine Lisa Wildner
Title
Director of Contracting & Research
Phone
(262) 875-6572

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
EEG Technician 2472E0500X NU
Sleep Disorder Diagnostic Clinic/Center 261QS1200X NU
Physiological Laboratory 293D00000X NU Primary
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier 335V00000X NU

Addresses

Primary practice location

941 E 86TH St Ste 107
Indianapolis, IN 46240-1842

Mailing address

626 W Moreland Blvd
Waukesha, WI 53188-2433
Phone (262) 754-0898

Other identifiers 1

IdentifierTypeStateIssuer
201132380AMedicaidIN

Other names 1

  • Neurotech Indiana Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130515000495 IN Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 6305948225 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Indianapolis, IN

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Neurotech LLC20 organizations share this tax ID, including this one
Part of
Neurotech LLC

Other organizations with this tax ID 19

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

View all 19

Locations

941 E 86th St
Ste 107
Indianapolis, IN 46240
Phone (262) 875-6611

Practitioners & affiliated clinicians

Practitioners 3

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": "1402963200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619136000000",
    "number": "1790199859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "626 W MORELAND BLVD",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531882433",
            "telephone_number": "262-754-0898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "941 E 86TH ST STE 107",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462401842",
            "telephone_number": "262-875-6611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEUROTECH, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NEUROTECH, LLC",
        "enumeration_date": "2014-06-17",
        "last_updated": "2021-04-23",
        "certification_date": "2021-04-23",
        "status": "A",
        "authorized_official_last_name": "WILDNER",
        "authorized_official_first_name": "KRISTINE",
        "authorized_official_middle_name": "LISA",
        "authorized_official_title_or_position": "DIRECTOR OF CONTRACTING & RESEARCH",
        "authorized_official_telephone_number": "262-875-6572"
    },
    "taxonomies": [
        {
            "code": "2472E0500X",
            "taxonomy_group": "",
            "desc": "Technician, Other, EEG",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QS1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Sleep Disorder Diagnostic",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "335V00000X",
            "taxonomy_group": "",
            "desc": "Portable X-ray and/or Other Portable Diagnostic Imaging Supplier",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201132380A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Neurotech Indiana",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Neurotech Indiana",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Indianapolis, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2021; 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.