NPIMap

Individual provider Active NPI

Samreena Rizeq, DNP

  • Family Nurse Practitioner
  • Kenosha, WI
National Provider Identifier
1811574270
Registry record updated May 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
9049-33 Issued in WI
Practice address
3100 Washington Rd
Kenosha, WI 53144-1604
Phone
(262) 658-4622
NPI assigned
Mar 24, 2021
Last updated
May 17, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 17, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X 9049-33 WI Primary

Addresses

Primary practice location

3100 Washington Rd
Kenosha, WI 53144-1604

Mailing address

2428 N Grandview Blvd Ste 102
Waukesha, WI 53188-6906
Phone (262) 875-5070

Other practice location 1

8633 32nd Ave
Kenosha, WI 53142-5187
Phone (262) 694-8300

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL None

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210401000089 WI Practitioner - Nurse Practitioner 4880001288 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Oak Medical SCGroup PAC ID 0042595175, 118 clinicians

Practice addresses (Care Compare)

18740 W Bluemound Rd
Brookfield, WI 53045-2936
Phone (262) 782-0230

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
9049-33WIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Maple Medical SC Single Specialty CurrentSince Apr 1, 2021 Accepting new patients
Oak Medical SC Single Specialty CurrentSince Apr 1, 2021 Accepting new patients

Locations

18740 W Bluemound Rd
Brookfield, WI 53045
Phone (262) 782-0230

3100 Washington Rd
Kenosha, WI 53144
Phone (262) 658-4039

8633 32nd Ave
Kenosha, WI 53142
Phone (262) 694-8300

2428 N Grandview Blvd
Waukesha, WI 53188
Phone (262) 875-5070

2428 N Grandview Blvd
Ste 102
Waukesha, WI 53188
Phone (262) 875-5070

N20W22961 Watertown Rd
Waukesha, WI 53186
Phone (262) 875-5070

Organizations & group practices 2

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

Hospital & facility affiliations 10

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": "1616544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684281600000",
    "number": "1811574270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2428 N GRANDVIEW BLVD STE 102",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531886906",
            "telephone_number": "262-875-5070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 WASHINGTON RD",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531441604",
            "telephone_number": "262-658-4622"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8633 32nd Ave",
            "address_purpose": "LOCATION",
            "city": "Kenosha",
            "state": "WI",
            "postal_code": "531425187",
            "country_code": "US",
            "telephone_number": "262-694-8300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RIZEQ",
        "first_name": "SAMREENA",
        "credential": "DNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-03-24",
        "last_updated": "2023-05-17",
        "certification_date": "2023-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "9049-33",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "None",
            "affiliation": "N",
            "address_1": "8633 32nd Ave",
            "city": "Kenosha",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531425187",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kenosha, WI

Sources for this page

Verify at the official NPI Registry.