Madison Neuropsychological Services LLC

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

3198-57 Issued in WI

Legal business name

MADISON NEUROPSYCHOLOGICAL SERVICES LLC

Practice address

6510 Grand Teton PLZ Ste 102
Ste 24
Madison, WI 53719

Phone

(608) 841-1606

Fax

(608) 492-2573

NPI assigned

Feb 29, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Sarah E Porter, PSYD

Title

Owner

Phone

(608) 841-1606

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 5

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

• Teresa M Susmaras, PHD

  • Clinical Neuropsychologist
  • La Crosse, WI
  • NPI 1710357017
  Medicare reassignment NPD
• Katarina Marsh, PSYD

  • Clinical Psychologist
  • Madison, WI
  • NPI 1376396903

  Clinical

  NPD
• Amy M Connell, MD

  • Psychiatry Physician
  • Janesville, WI
  • NPI 1396781985
  NPD (past)
• Elliot R Lee, M.D.

  • Psychiatry Physician
  • Madison, WI
  • NPI 1669602439
  NPD (past)
• Lawrence J Mandt, PH.D.

  • Psychologist
  • Madison, WI
  • NPI 1255361002

  Clinical

  NPD (past)

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

{
    "created_epoch": "1456704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529539200000",
    "number": "1982064366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6510 GRAND TETON PLZ STE 102",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537191031",
            "telephone_number": "608-841-1606",
            "fax_number": "608-492-2573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6510 GRAND TETON PLZ STE 102",
            "address_2": "STE 24",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "53719",
            "telephone_number": "608-841-1606",
            "fax_number": "608-492-2573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MADISON NEUROPSYCHOLOGICAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-29",
        "last_updated": "2018-06-21",
        "status": "A",
        "authorized_official_last_name": "PORTER",
        "authorized_official_first_name": "SARAH",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "608-841-1606",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "WI",
            "license": "3198-57",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "3198-57",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Madison, WI
• Clinical Neuropsychologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2018; 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.