Clinton Charles Warren, M.D.

Primary specialty

Retina Specialist (Ophthalmology) PhysicianTaxonomy code 207WX0107X

License

61666-20 Issued in WI

Practice address

5017 Green Bay Rd Ste 148
Kenosha, WI 53144-1782

Phone

(262) 420-5888

Fax

(262) 420-5888

NPI assigned

Apr 3, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Ophthalmology

Education

Wake Forest University School of Medicine, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as individual

Quality

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cwarren@tcr.emadirect.md

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Third Coast Retina S.C.

  • Retina Specialist (Ophthalmology) Physician
  • Kenosha, WI
  • NPI 1831823921
  Medicare reassignment NPD Authorized official
• The Medical College of Wisconsin, Inc.

  • Internal Medicine Physician
  • Milwaukee, WI
  • NPI 1699720086
  Medicare reassignment NPD
• Southport Rehab Associates, Inc

  • Rehabilitation Clinic/Center
  • Kenosha, WI
  • NPI 1114929064
  NPD (past)

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

{
    "created_epoch": "1333411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660089600000",
    "number": "1902162076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5017 GREEN BAY RD STE 148",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531441782",
            "telephone_number": "262-420-5888",
            "fax_number": "262-420-5889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5017 GREEN BAY RD STE 148",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531441782",
            "telephone_number": "262-420-5888",
            "fax_number": "262-420-5888"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "925 N 87th St",
            "address_2": "The Eye Institute",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532264812",
            "country_code": "US",
            "telephone_number": "414-456-2020",
            "fax_number": "414-456-6300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WARREN",
        "first_name": "CLINTON",
        "middle_name": "CHARLES",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-03",
        "last_updated": "2022-08-10",
        "certification_date": "2022-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207WX0107X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Retina Specialist",
            "state": "WI",
            "license": "61666-20",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1902162076",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jill Ann Walker, PHARMD
• Shanise Wallace
• Stacey Wallace, RN
• Michael Anthony Walsh, D.D.S.
• John James Walther, BS
• Eileen G Warren, MS, CSAC - ICS
• Melanie Waschbisch, LPC
• Roena Angela Waters, ADULT FAMILY HOME
• Jason T Watka
• Brian M Watkins, PTA

• Retina Specialist (Ophthalmology) Physician in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Retina Specialist (Ophthalmology) Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.