NPIMap

Organization Active NPI

Children's Medical Group

Doing business as North Shore Pediatrics

  • Pediatrics Physician
  • Mequon, WI
National Provider Identifier
1801061064
Registry record updated Sep 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
CHILDREN'S MEDICAL GROUP
Doing business as
North Shore Pediatrics
Practice address
1655 W. Mequon Road
Mequon, WI 53092-3230
Phone
(262) 240-9744
Fax
(262) 240-9745
NPI assigned
Apr 28, 2008
Last updated
Sep 24, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
CHILDREN'S MEDICAL GROUPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 24, 2021

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

Authorized official

Name
Dr. Smriti Khare, MD
Title
President, Children's Medical Group
Phone
(414) 266-7615

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU
Professional Counselor 101YP2500X NU
Clinical Child & Adolescent Psychologist 103TC2200X NU
Social Worker 104100000X NU
Clinical Social Worker 1041C0700X NU
Marriage & Family Therapist 106H00000X NU
Pediatrics Physician 208000000X NU Primary
Psychiatry Physician 2084P0800X NU
Child & Adolescent Psychiatry Physician 2084P0804X NU

Addresses

Primary practice location

1655 W. Mequon Road
Mequon, WI 53092-3230

Mailing address

9000 W Wisconsin Ave
Ms 958
Milwaukee, WI 53226-4874
Phone (414) 266-7615

Other identifiers 1

IdentifierTypeStateIssuer
1801061064MedicaidWI

Other names 1

  • North Shore Pediatrics Doing business as

National Provider Directory

National Provider Directory
Tax ID family
CMG Inc Pediatric CNSL38 organizations share this tax ID, including this one
Part of
CMG Inc Pediatric CNSL

Other organizations with this tax ID 37

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

View all 37

NPI Registry JSON

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

{
    "created_epoch": "1209340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632441600000",
    "number": "1801061064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9000 W WISCONSIN AVE",
            "address_2": "MS 958",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532264874",
            "telephone_number": "414-266-7615",
            "fax_number": "414-266-1853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1655 W. MEQUON ROAD",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530923230",
            "telephone_number": "262-240-9744",
            "fax_number": "262-240-9745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDREN'S MEDICAL GROUP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHILDREN'S MEDICAL GROUP",
        "enumeration_date": "2008-04-28",
        "last_updated": "2021-09-24",
        "certification_date": "2021-09-24",
        "status": "A",
        "authorized_official_last_name": "KHARE",
        "authorized_official_first_name": "SMRITI",
        "authorized_official_title_or_position": "PRESIDENT, CHILDREN'S MEDICAL GROUP",
        "authorized_official_telephone_number": "414-266-7615",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1801061064",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Shore Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "North Shore Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mequon, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2021; 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.