WEST BEND CLINIC, INC. (NPI# 1326057795) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326057795 |
| Entity Type | Organization |
| Organization Name | WEST BEND CLINIC, INC. |
| Other Organization Name | HARTFORD CLINIC |
| Practice Address |
110 Lone Oak Ln Hartford WI 53027-2600 |
| Mailing Address |
1700 W Paradise Dr West Bend WI 53095-9795 |
| Practice Telephone | 2626701800 |
| Mailing Telephone | 2623343451 |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2012-05-23 |
| Authorized Official Name | GREGORY G BLOMMEL (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 2623343451 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207V00000X | Obstetrics & Gynecology | Allopathic & Osteopathic Physicians | ||
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 21251400 | 05 |
| Other Name | Type Code |
|---|---|
| Hartford Clinic | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124328232 | West Bend Clinic, Inc. | Physical Therapist | W227 N16857 Tillie Lake Court, Jackson, WI 53037-9000 | 2010-10-25 |
| 1780821298 | West Bend Clinic, Inc. | Orthopaedic Surgery | W180n8085 Town Hall Rd, Menomonee Falls, WI 53051-3518 | 2009-01-21 |
| 1043220692 | West Bend Clinic, Inc. | Dermatology | 1190 E Paradise Dr, West Bend, WI 53095-5444 | 2006-08-08 |
| 1558371104 | West Bend Clinic, Inc. | Internal Medicine | 3200 Pleasant Valley Rd, West Bend, WI 53095-9274 | 2006-08-08 |
| 1235106311 | West Bend Clinic, Inc. | Internal Medicine | 1700 W Paradise Dr, West Bend, WI 53095-9795 | 2006-03-07 |
| Street Address |
110 LONE OAK LN |
| City | HARTFORD |
| State | WI |
| Zip Code | 53027-2600 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356348031 | Robert George Cesarec | Family Medicine | 110 Lone Oak Ln, Hartford Health Center, Hartford, WI 53027-2600 | 2005-07-07 |
| 1952832495 | Eric Uting | Family Medicine | 110 Lone Oak Ln, Hartford, WI 53027-2600 | 2017-03-26 |
| 1942689047 | Froedtert & The Medical College of Wisconsin Community Physicians Inc | Clinical Medical Laboratory | 110 Lone Oak Ln, Hartford, WI 53027-2600 | 2015-05-21 |
| 1205227501 | Marie Kujawa | Physical Therapist | 110 Lone Oak Ln, Hartford Health Center, Hartford, WI 53027-2600 | 2015-02-09 |
| 1881090579 | Samantha Brovelli | Physical Therapist | 110 Lone Oak Ln, Hartford Health Center, Hartford, WI 53027-2600 | 2014-11-07 |
| 1235539826 | Elizabeth Baldwin | Nurse Practitioner | 110 Lone Oak Ln, Hartford, WI 53027-2600 | 2014-09-02 |
| 1114330123 | Gretchen Rakowski | Physical Therapist | 110 Lone Oak Ln, Hartford, WI 53027-2600 | 2014-06-06 |
| 1609214121 | Froedtert & The Medical College of Wisconsin Community Physicians | Durable Medical Equipment & Medical Supplies | 110 Lone Oak Ln, Hartford, WI 53027-2600 | 2013-06-06 |
| 1235271958 | Edward Cooney | Internal Medicine | 110 Lone Oak Ln, Hartford, WI 53027-2600 | 2007-02-12 |
| 1891752903 | Terrence P Hughes | Family Medicine | 110 Lone Oak Ln, Hartford, WI 53027-2600 | 2006-05-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942792254 | Quad/med, LLC | Clinic/Center | 1900 W. Sumner Street, Hartford, WI 53027 | 2018-06-01 |
| 1700390242 | Dr. Espinosa Dds Tooth Or Gum, LLC | Dentist | 784 South Main St, Hartford, WI 53027 | 2017-11-20 |
| 1598169559 | Amy Jo Hoeppner | Registered Nurse | 1621 Falcon Dr., Hartford, WI 53027 | 2014-10-20 |
| 1205179918 | Susan Aleen Sterman | Technician | 4835 Cty Rd U, Hartford, WI 53027 | 2013-04-01 |
| 1881927713 | Ross Timothy Koehler | Specialist/Technologist | 1900 W Sumner St, Hartford, WI 53027 | 2009-09-10 |
| 1518130004 | Kamalpreet Dulai | Family Medicine | 110 Lone Oak Lane, Hartford, WI 53027 | 2008-04-07 |
| 1679775688 | Kelly M Schroeder | Physical Therapist | 1640 E. Sumner Street, Hartford, WI 53027 | 2007-06-01 |
| 1871794453 | Sandra Ann Weber | Registered Nurse | 4815 North Merton Drive, Hartford, WI 53027 | 2007-05-30 |
| 1306051743 | Agnes P Dietenberger | Physical Therapy Assistant | 1640 E. Sumner St., Hartford, WI 53027 | 2007-05-11 |
| 1164636619 | Robert W Fulton | Physical Therapist | 1640 East Sumner Street, Hartford, WI 53027 | 2007-05-10 |
| Find all providers in zip 53027 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891159596 | Andrea Leigh Gillis | Family Medicine | Family Medicine Center At Asylum Hill, 99 Woodland St, Hartford, CT 06105 | 2016-04-08 |
| 1366679565 | William C Popik | Family Medicine | 90 Goodwin Cir, Hartford, CT 06105-5205 | 2009-06-15 |
| 1093989519 | Vivian Olsen Simmons | Family Medicine | 169 2nd Avenue, Hartford, AL 36344-1219 | 2008-04-15 |
| 1518130004 | Kamalpreet Dulai | Family Medicine | 110 Lone Oak Lane, Hartford, WI 53027 | 2008-04-07 |
| 1780877381 | Ohio County Hospital Corporation | Family Medicine | 20 Mcmurty Avenue, Hartford, KY 42347 | 2007-08-27 |
| 1912928169 | Collins Medical Associates 2 PC | Family Medicine | 95 Woodland St Fl 1, Hartford, CT 06105-1230 | 2006-07-22 |
| 1942225313 | Richard Thomas Kennedy | Family Medicine | 169 North Second Ave, Hartford, AL 36344 | 2006-07-13 |
| 1417908948 | Suzanne Gehl | Family Medicine | 1023 W State St, Hartford, WI 53027-2726 | 2006-05-12 |
| 1386609543 | Kellie Distefano | Family Medicine | 525 S Center St, Hartford, MI 49057-1362 | 2006-04-19 |
| 1851362180 | Kevin Lamont Collins | Family Medicine | 19 Woodland Street, Suite 42, Hartford, CT 06105 | 2006-01-26 |
| Find all providers in HARTFORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.