Family Medicine & Surgery LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

26462 Issued in WI

Legal business name

FAMILY MEDICINE & SURGERY LLC

Practice address

3066 Main St
East Troy, WI 53120-1148

Phone

(262) 642-7313

Fax

(262) 642-4251

NPI assigned

Feb 24, 2011

Last updated

Feb 24, 2011By 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

Dr. Neil James Rennick, D.O.NPI 1508062043

Title

Sole Proprietor

Phone

(262) 642-7313

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Neil James Rennick, DO

  • Family Medicine Physician
  • East Troy, WI
  • NPI 1508062043
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1298505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1298505600000",
    "number": "1922305077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3066 MAIN ST",
            "city": "EAST TROY",
            "state": "WI",
            "postal_code": "531201148",
            "telephone_number": "262-642-7313",
            "fax_number": "262-642-4251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3066 MAIN ST",
            "city": "EAST TROY",
            "state": "WI",
            "postal_code": "531201148",
            "telephone_number": "262-642-7313",
            "fax_number": "262-642-4251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY MEDICINE & SURGERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-24",
        "last_updated": "2011-02-24",
        "status": "A",
        "authorized_official_last_name": "RENNICK",
        "authorized_official_first_name": "NEIL",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "SOLE PROPRIETOR",
        "authorized_official_telephone_number": "262-642-7313",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "WI",
            "license": "26462",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF WISCONSIN LICENSE",
            "identifier": "26462",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "80591",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TYPE 1 NPI",
            "identifier": "1508062043",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30100300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David F Devries, PA-C
• East Troy Area Emergency Services District
• East Troy Community School District
• East Troy Family Dental Center SC
• Rachel Marie Eaton, RN BSN
• Megan Ferlindes, PT, DPT
• Lauren Christen Fleming
• Kimberly Ann Gottsacker, PTA
• Lori L Hall, MSW LCSW
• Callie Lee Hastings, LPN

• General Practice Physician in East Troy, WI
• Providers in East Troy, WI by specialty
• General Practice Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2011; 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.