NPIMap

Phoenixc Healthcare, SC

Organization Active NPI Clinical Cardiac Electrophysiology Physician · Kenosha, WI

NPI 1821591710 · NPPES record last updated Mar 16, 2018

Key facts

NPI
1821591710
Entity type
Organization (NPI type 2)
Primary specialty
Clinical Cardiac Electrophysiology Physician 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
Organization subpart
No

Authorized official

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

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

Practitioners 32

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 32

Medicare participation

Medicare fee-for-service enrollment
Enrolled in WI

Medicare enrollment records

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

Locations

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

9555 76th St
Ste 2630
Pleasant Prairie, WI 53158
Phone (262) 656-3650

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Cardiac Electrophysiology Physician
Group: 193400000X SINGLE SPECIALTY GROUP		 207RC0001X Yes

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 16, 2018.

{
    "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

All providers in Kenosha, WI · Clinical Cardiac Electrophysiology Physician in Wisconsin

Sources for this page

Verify at the official NPI Registry.