Watertown Family Practice Associates S.C.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

WATERTOWN FAMILY PRACTICE ASSOCIATES S.C.

Practice address

127 Hospital Dr
Watertown, WI 53098-3303

Phone

(920) 261-8500

NPI assigned

Nov 30, 2006

Last updated

Apr 7, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Michael E Sullivan, M.D.NPI 1093883142

Title

Clinic President

Phone

(920) 261-8500

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/20962/brand/1/csg/1/fhir/r4

Practitioners 20

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.

• Michael E Sullivan, M.D.

  • Family Medicine Physician
  • Watertown, WI
  • NPI 1093883142
  Medicare reassignment Care Compare group NPD Authorized official
• John R Basarich, MD

  • Family Medicine Physician
  • Watertown, WI
  • NPI 1033178512
  Medicare reassignment Care Compare group NPD
• Robert Steven Legrow, M.D.

  • Family Medicine Physician
  • Watertown, WI
  • NPI 1013908771
  Medicare reassignment Care Compare group NPD
• Carmen D Papenfuss, FNP-BC

  • Family Nurse Practitioner
  • Waukesha, WI
  • NPI 1699300137
  Medicare reassignment Care Compare group NPD
• Anna Christa Stamas, DO

  • Family Medicine Physician
  • Watertown, WI
  • NPI 1376172007
  Medicare reassignment Care Compare group NPD
• Sara Stiller

  • Nurse Practitioner
  • Mequon, WI
  • NPI 1558143073
  Medicare reassignment Care Compare group NPD
• Danielle G. Tonelli, DO

  • Family Medicine Physician
  • Watertown, WI
  • NPI 1083806814
  Medicare reassignment Care Compare group NPD
• Holly A Wallace, APNP

  • Nurse Practitioner
  • Summit, WI
  • NPI 1124660592
  Medicare reassignment Care Compare group NPD
• Alyssa Jean Flagge, PA-C

  • Physician Assistant
  • Watertown, WI
  • NPI 1356074512
  Medicare reassignment Care Compare group
• Lauren Ashley Pederson, PA-C

  • Medical Physician Assistant
  • Watertown, WI
  • NPI 1184252504
  Medicare reassignment Care Compare group
• Andrea Marie Cantwell-Durand, RNC, APNP

  • Family Nurse Practitioner
  • Sussex, WI
  • NPI 1396921375
  Medicare reassignment NPD
• Bruce J Cochrane, M.D.

  • Family Medicine Physician
  • Watertown, WI
  • NPI 1922176064
  Medicare reassignment NPD

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

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649289600000",
    "number": "1811064942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "127 HOSPITAL DR",
            "city": "WATERTOWN",
            "state": "WI",
            "postal_code": "530983303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "127 HOSPITAL DR",
            "city": "WATERTOWN",
            "state": "WI",
            "postal_code": "530983303",
            "telephone_number": "920-261-8500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERTOWN FAMILY PRACTICE ASSOCIATES S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-30",
        "last_updated": "2022-04-07",
        "certification_date": "2022-04-07",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CLINIC PRESIDENT",
        "authorized_official_telephone_number": "920-261-8500",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32687900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Watertown Anesthesia, LLC
• Watertown Anesthesiology SC
• Watertown Chiropractic SC
• Watertown Emergency Physicians
• Watertown Emergency Physicians, S.C.
• Watertown Heart Institute SC
• Watertown Hometown Pharmacy LLC (Watertown Hometown Pharmacy)
• Watertown Internal Medicine SC
• Watertown Medical Center LLC
• Watertown Medical Center LLC (Watertown Regional Medical Center)

• Family Medicine Physician in Watertown, WI
• Providers in Watertown, WI by specialty
• Family Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.