NPIMap

Organization Active NPI

CJ Hussussian MD SC

  • Plastic Surgery Physician
  • Waukesha, WI
National Provider Identifier
1831260405
Registry record updated Nov 21, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
46664-020 Issued in WI
Legal business name
CJ HUSSUSSIAN MD SC
Practice address
N4W22370 Bluemound Rd
Suite 100
Waukesha, WI 53186-1683
Phone
(262) 970-5600
Fax
(262) 970-5950
NPI assigned
Nov 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2013

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

Authorized official

Name
C J Hussussian
Title
Plastic Surgeon
Phone
(262) 970-5600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208200000X 46664-020 WI Primary

Addresses

Primary practice location

N4W22370 Bluemound Rd
Suite 100
Waukesha, WI 53186-1683

Mailing address

N4W22370 Bluemound Rd
Suite 100
Waukesha, WI 53186-1683
Phone (262) 970-5600

Other identifiers 1

IdentifierTypeStateIssuer
34515700MedicaidWI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040710000316 WI Part B Supplier - Clinic/Group Practice 1456339993 Receives reassigned benefits from 8 practitioners
Practice locations: Waukesha, WI; West Allis, WI; Mukwonago, WI; Milwaukee, WI; Brookfield, WI

National Provider Directory

National Provider Directory

Locations

785 Summit Ave
Ste 303
Oconomowoc, WI 53066
Phone (262) 560-4579

Practitioners & affiliated clinicians

Practitioners 10

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

NPI Registry JSON

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384992000000",
    "number": "1831260405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N4W22370 BLUEMOUND RD",
            "address_2": "SUITE 100",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531861683",
            "telephone_number": "262-970-5600",
            "fax_number": "262-970-5950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N4W22370 BLUEMOUND RD",
            "address_2": "SUITE 100",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531861683",
            "telephone_number": "262-970-5600",
            "fax_number": "262-970-5950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CJ HUSSUSSIAN MD SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-13",
        "last_updated": "2013-11-21",
        "status": "A",
        "authorized_official_last_name": "HUSSUSSIAN",
        "authorized_official_first_name": "C",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PLASTIC SURGEON",
        "authorized_official_telephone_number": "262-970-5600"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Plastic Surgery",
            "state": "WI",
            "license": "46664-020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34515700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waukesha, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2013; 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.