Active NPI
Brendon Kyle Luvisa, MD
- Plastic Surgery Physician
- Madison, WI
National Provider Identifier
1790311660
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Plastic Surgery Physician
- License
- 86380-20
- Practice address
- 1255 Fourier Dr Ste 102
Madison, WI 53717-2176 - Phone
- (608) 903-9253
- NPI assigned
- Mar 23, 2020
- Last updated
- Jan 27, 2026
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Plastic Surgery Physician | 208200000X | 86380-20 | WI | Primary |
Addresses
Primary practice location
1255 Fourier Dr Ste 102
Madison, WI 53717-2176
Mailing address
1255 Fourier Dr Ste 102
Madison, WI 53717-2176
Phone (608) 903-9253
Other names 1
- Brendon Kyle Luvisa
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210113000064 | CA | Order and Referring Only - Plastic and Reconstructive Surgery | 0244643252 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86380-20 | WI | MD | Plastic Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1584921600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1769472000000",
"number": "1790311660",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1255 FOURIER DR STE 102",
"city": "MADISON",
"state": "WI",
"postal_code": "537172176",
"telephone_number": "608-903-9253"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1255 FOURIER DR STE 102",
"city": "MADISON",
"state": "WI",
"postal_code": "537172176",
"telephone_number": "608-903-9253"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUVISA",
"first_name": "BRENDON",
"middle_name": "KYLE",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-03-23",
"last_updated": "2026-01-27",
"certification_date": "2026-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "208200000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Plastic Surgery",
"state": "WI",
"license": "86380-20",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "BRENDON",
"last_name": "LUVISA",
"middle_name": "KYLE",
"credential": "MD",
"code": "2",
"type": "Professional Name"
}
]
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.