Great Lakes Dermatology SC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

GREAT LAKES DERMATOLOGY SC

Practice address

6233 Bankers Rd
Suite 3
Mount Pleasant, WI 53403-9700

Phone

(262) 898-4400

Fax

(262) 898-4423

NPI assigned

Nov 28, 2006

Organization subpart

No

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

Authorized official

Name

Kristy K Olson

Title

Manager of Compliance

Phone

(262) 989-4400

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• ASCEND DERMATOLOGY Doing business as

Locations

Practitioners 5

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

• Laura E Marusinec, MD

  • Pediatrics Physician
  • New Berlin, WI
  • NPI 1730111998
  NPD (past)
• Tracy Arnold, APNP

  • Nurse Practitioner
  • Centralia, IL
  • NPI 1952660300
  NPD (past)
• Meejung Belasco, APNP

  • Nurse Practitioner
  • Riverside, CA
  • NPI 1144459892
  NPD (past)
• Kelsey Grimmer, PA

  • Medical Physician Assistant
  • Lake Forest, IL
  • NPI 1265695530
  NPD (past)
• Dara D Spearman, MD

  • Dermatology Physician
  • Fort Wayne, IN
  • NPI 1588783419
  NPD (past)

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1432598400000",
    "number": "1851467047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6233 BANKERS RD STE 3",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "534039700",
            "telephone_number": "262-898-4400",
            "fax_number": "262-898-4423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6233 BANKERS RD",
            "address_2": "SUITE 3",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "534039700",
            "telephone_number": "262-898-4400",
            "fax_number": "262-898-4423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES DERMATOLOGY SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2015-05-26",
        "status": "A",
        "authorized_official_last_name": "OLSON",
        "authorized_official_first_name": "KRISTY",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "MANAGER OF COMPLIANCE",
        "authorized_official_telephone_number": "262-989-4400"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CH7592",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ASCEND DERMATOLOGY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Thomas Edward Goodrich, M.D.
• Kristin M Gordon
• Thomas James Gorski, DDS
• Isabella Emily Gosda
• Lekesha Annette Grays
• Great Lakes Healthcare, Inc.
• Jacob John Gricar, PT, DPT, LAT
• Lindsay Caroline Grisham, NNP
• Emily Grochowski, PHARMD
• Guardian Recovery - Virtual Counseling LLC

• Dermatology Physician in Mount Pleasant, WI
• Providers in Mount Pleasant, WI by specialty
• Dermatology Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.