Individual provider Active NPI

Charles R Spelich, D.O.

  • Family Medicine Physician
  • Milwaukee, WI
National Provider Identifier
1811334675
Registry record updated Oct 31, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
68209 Issued in WI
Practice address
2311 N Prospect Ave
Milwaukee, WI 53211-4445
Phone
(414) 319-3000
Fax
(414) 319-3033
NPI assigned
Jun 3, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 68209 WI Primary

Addresses

Primary practice location

2311 N Prospect Ave
Milwaukee, WI 53211-4445

Mailing address

2311 N Prospect Ave
Milwaukee, WI 53211-4445
Phone (414) 319-3000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171117002413 WI Practitioner - Family Practice 8921221888 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Midwestern University, Chicago College of Osteopathic Med, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2311 N Prospect Ave
Milwaukee, WI 53211-4445
Phone (414) 319-3000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
68209WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Columbia St. Mary'S Hospital Milwaukee, Inc Family Medicine Current Accepting new patients
Columbia St. Mary'S Hospital Milwaukee, Inc CurrentSince Nov 1, 2017 Accepting new patients
Columbia St. Mary'S Hospital Milwaukee Inc CurrentSince Nov 1, 2017 Accepting new patients
Ascension Medical Group-Southeast Wisconsin Inc Family Medicine CurrentSince Nov 12, 2018 Accepting new patients
Columbia St. Mary'S Hospital Milwaukee, Inc Family Medicine Past Accepting new patients

Locations

13950 W Capitol Dr
Brookfield, WI 53005
Phone (414) 302-5400

400 W River Woods Pkwy
Glendale, WI 53212
Phone (414) 465-3000

2311 N Prospect Ave
Milwaukee, WI 53211
Phone (414) 319-3000

4027 N Oakland Ave
Shorewood, WI 53211
Phone (414) 319-3080

201 N Mayfair Rd
Fl 2
Wauwatosa, WI 53226
Phone (414) 771-8228

801 S 70th St
West Allis, WI 53214
Phone (414) 773-6600

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1370217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1509408000000",
    "number": "1811334675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2311 N PROSPECT AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532114445",
            "telephone_number": "414-319-3000",
            "fax_number": "414-319-3033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2311 N PROSPECT AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532114445",
            "telephone_number": "414-319-3000",
            "fax_number": "414-319-3033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPELICH",
        "first_name": "CHARLES",
        "middle_name": "R",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-03",
        "last_updated": "2017-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "68209",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.