State Medicaid

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

Legal business name

STATE MEDICAID

Practice address

824 Lothe St
Sun Prairie, WI 53590-2710

Phone

(608) 334-0900

NPI assigned

Sep 7, 2006

Organization subpart

No

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

Authorized official

Name

Miss Janice Remus, RN

Title

Case Manager

Phone

(608) 848-7745

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1157587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1891898219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "824 LOTHE ST",
            "city": "SUN PRAIRIE",
            "state": "WI",
            "postal_code": "535902710",
            "telephone_number": "608-334-0900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "824 LOTHE ST",
            "city": "SUN PRAIRIE",
            "state": "WI",
            "postal_code": "535902710",
            "telephone_number": "608-334-0900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE MEDICAID",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "REMUS",
        "authorized_official_first_name": "JANICE",
        "authorized_official_title_or_position": "CASE MANAGER",
        "authorized_official_telephone_number": "608-848-7745",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jodi Stacey, MFT-IT
• Phillip L. Stall, MD
• April Marie Stalsberg, LPN
• Ashley Stankey
• Nicole Stanley, OTR/L
• Lawrence James Stava, PH.D.
• Zoe Steinmetz, RN
• Stephanie M Stenseth, APNP
• Christopher John Stevens, DDS
• Genevieve Nicole Stevens, CPM

• Preferred Provider Organization in Sun Prairie, WI
• Providers in Sun Prairie, WI by specialty
• Preferred Provider Organization in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.