NPIMap

Organization Active NPI

Phoenixc Healthcare, SC

  • Clinical Cardiac Electrophysiology Physician
  • Kenosha, WI
National Provider Identifier
1821591710
Registry record updated Mar 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Cardiac Electrophysiology PhysicianTaxonomy code 207RC0001X
Legal business name
PHOENIXC HEALTHCARE, SC
Practice address
6121 Green Bay Rd Ste 100
Kenosha, WI 53142-2931
Phone
(708) 488-9515
NPI assigned
Mar 16, 2018
Last updated
Mar 16, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2018

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

Authorized official

Name
Indrajit Choudhuri, MDNPI 1467621110
Title
President
Phone
(708) 488-9515

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Cardiac Electrophysiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RC0001X Primary

Addresses

Primary practice location

6121 Green Bay Rd Ste 100
Kenosha, WI 53142-2931

Mailing address

11168 N Lake Shore Dr
Mequon, WI 53092-5811

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180426000464 WI Part B Supplier - Clinic/Group Practice 6002170149 Receives reassigned benefits from 1 practitioner
Practice locations: Kenosha, WI

National Provider Directory

National Provider Directory

Locations

6121 Green Bay Rd
Ste 100
Kenosha, WI 53142
Phone (262) 945-7557

Practitioners & affiliated clinicians

Practitioners 32

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.

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1521158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521158400000",
    "number": "1821591710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11168 N LAKE SHORE DR",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530925811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6121 GREEN BAY RD STE 100",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531422931",
            "telephone_number": "708-488-9515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIXC HEALTHCARE, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-16",
        "last_updated": "2018-03-16",
        "status": "A",
        "authorized_official_last_name": "CHOUDHURI",
        "authorized_official_first_name": "INDRAJIT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-488-9515",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RC0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kenosha, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.