Spine Solutions of Sheboygan LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

SPINE SOLUTIONS OF SHEBOYGAN LLC

Practice address

2124 Kohler Memorial Dr
Sheboygan, WI 53081-3169

Phone

(414) 455-1153

NPI assigned

Oct 29, 2020

Last updated

Oct 29, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jeremy Scarlett, MD

Title

Owner

Phone

(414) 455-1153

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Listed as

Spine Solutions of Sheboygan LLCCCN 52C0001139

Medicare certification status

ActiveFrom the Provider of Services file

Tax ID family

Spine Solutions of Sheboygan2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Spine Solutions of Sheboygan LLC

  • Durable Medical Equipment & Medical Supplies
  • Sheboygan, WI
  • NPI 1093522161
  NPD tax ID

Locations

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

{
    "created_epoch": "1603929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603929600000",
    "number": "1891395661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2124 KOHLER MEMORIAL DR",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "530813169",
            "telephone_number": "414-455-1153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2124 KOHLER MEMORIAL DR",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "530813169",
            "telephone_number": "414-455-1153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPINE SOLUTIONS OF SHEBOYGAN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-29",
        "last_updated": "2020-10-29",
        "certification_date": "2020-10-29",
        "status": "A",
        "authorized_official_last_name": "SCARLETT",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "414-455-1153",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Abdelouahid Souala, MD
• Curtis M Spaulding, RDH
• Jennifer L Specht, PHD
• Suzanne Marie Speltz, LCSW
• Spine Solutions of Sheboygan LLC
• Spinelli Group LLC (SYNERGY HomeCare of Sheboygan)
• St Nicholas Hospital -Sisters of Third Order of St Francis
• St Nicholas Hospital of the Hospital Sisters of St Francis (Prevea Health Employer Services)
• St Nicholas Hospital-Sisters of the Third Order of St Francis (Prevea Health-Sheboygan Therapy DME Supplier)
• St Nicholas Hospital-Sisters of the Third Order of St Francis (St Nicholas Hospital Professional Services Group)

• Ambulatory Surgical Clinic/Center in Sheboygan, WI
• Providers in Sheboygan, WI by specialty
• Ambulatory Surgical Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.