JEFFREY LAWRENCE CRECELIUS (NPI# 1477521573) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1477521573 |
| Entity Type | Individual |
| Full Name | JEFFREY LAWRENCE CRECELIUS |
| Credential | MD |
| Practice Address |
721 American Ave Ste 108 Waukesha WI 53188-5071 |
| Mailing Address |
8333 Naab Rd Suite 250 Indianapolis IN 46260-5924 |
| Practice Telephone | 2629288200 |
| Mailing Telephone | 3173961300 |
| Mailing Fax Number | 3173961346 |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2018-10-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207T00000X | Neurological Surgery | 69263-20 | WI | Allopathic & Osteopathic Physicians |
| N | 207T00000X | Neurological Surgery | 01036963A | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | ANTHEM BLUE CROSS AND BLUE SHIELD | 000000580227 | 01 |
| IN | CAQH NUMBER | 10824947 | 01 |
| IN | 100087570 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043217466 | Jeffrey W Crecelius | Pediatrics | 3855 Trueman Ct, Hilliard, OH 43026-2496 | 2005-06-30 |
| Street Address |
721 AMERICAN AVE STE 108 |
| City | WAUKESHA |
| State | WI |
| Zip Code | 53188-5071 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972578466 | Nihal Herath | Specialist | 721 American Ave Ste 108, Waukesha, WI 53188-5071 | 2006-02-20 |
| 1114360336 | Melissa Learned | Specialist | 721 American Ave Ste 108, Waukesha, WI 53188-5071 | 2013-04-08 |
| 1629324736 | Tatyana M Gerachshenko | Physical Medicine & Rehabilitation | 721 American Ave Ste 108, Waukesha, WI 53188-5071 | 2012-07-25 |
| 1992862551 | Laura Lynn Raftery | Internal Medicine | 721 American Ave Ste 108, Prohealth Care Regional Cancer Center, Waukesha, WI 53188-5071 | 2007-01-02 |
| 1407948763 | Peter Haan Johnson | Internal Medicine | 721 American Ave Ste 108, Prohealth Care Regional Cancer Center, Waukesha, WI 53188-5071 | 2006-09-28 |
| 1518928993 | Timothy R Wassenaar | Internal Medicine | 721 American Ave Ste 108, Prohealth Care Regional Cancer Center, Waukesha, WI 53188-5071 | 2006-03-28 |
| 1134198567 | Randy L Gehring | Neurological Surgery | 721 American Ave Ste 108, Waukesha, WI 53188-5071 | 2006-03-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336787126 | Nicole Lee Berg-johnson | Nurse Practitioner | 820 Crestwood Dr., Waukesha, WI 53188 | 2019-12-12 |
| 1013475706 | Rachel Mueller | Occupational Therapist | 29667 Summit Ave, S11, Waukesha, WI 53188 | 2019-03-12 |
| 1861962649 | Emily Elizabeth Seefeld | Occupational Therapy Assistant | 29667 Summit Ave S11, Waukesha, WI 53188 | 2018-12-05 |
| 1003393307 | Ashley Susan Callahan | Dental Hygienist | 711 W. Moreland Blvd., Suite 204, Waukesha, WI 53188 | 2018-07-19 |
| 1245741321 | Melissa Weir | Case Manager/Care Coordinator | 514 Riverview Avenue, Waukesha, WI 53188 | 2017-10-17 |
| 1093233629 | Patricia Marie Sombrio | Dental Hygienist | 711 Moreland Blvd 204, Waukesha, WI 53188 | 2017-09-04 |
| 1134660244 | Bdg of Wisconsin, Inc. | Behavioral Analyst | N19w2309 Riverwood Drive, Suite 350 Pmb 314, Waukesha, WI 53188 | 2017-03-09 |
| 1255888731 | Lynne Sarah Alva | Dental Hygienist | 711 Moreland Blvd, Suite 204, Waukesha, WI 53188 | 2016-09-01 |
| 1881069730 | Michelle Koch | Occupational Therapist | 29667 Summit Ave. S11, Waukesha, WI 53188 | 2015-12-03 |
| 1952711012 | Rhonda Schroeder | Dental Hygienist | W286 N991 Shepherds Way, Waukesha, WI 53188 | 2014-04-29 |
| Find all providers in zip 53188 | ||||
| Taxonomy Code | 207T00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Neurological Surgery |
| A neurological surgeon provides the operative and non-operative management (i.e., prevention, diagnosis, evaluation, treatment, critical care, and rehabilitation) of disorders of the central, peripheral, and autonomic nervous systems, including their supporting structures and vascular supply; the evaluation and treatment of pathological processes which modify function or activity of the nervous system; and the operative and non-operative management of pain. A neurological surgeon treats patients with disorders of the nervous system; disorders of the brain, meninges, skull, and their blood supply, including the extracranial carotid and vertebral arteries; disorders of the pituitary gland; disorders of the spinal cord, meninges, and vertebral column, including those which may require treatment by spinal fusion or instrumentation; and disorders of the cranial and spinal nerves throughout their distribution. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Neurological Surgery, 2007. http://www.abns.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Neurological Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043228141 | Christopher King | Neurological Surgery | 1111 Delafield St Ste 105, Waukesha, WI 53188-3402 | 2006-08-04 |
| 1083614515 | David Christian Hemmy | Neurological Surgery | 20611 Watertown Rd, Suite J, Waukesha, WI 53186-1871 | 2005-07-27 |
| 1891901229 | David C Hemmy Md Ltd | Neurological Surgery | 20611 Watertown Rd, Suite J, Waukesha, WI 53186-1871 | 2007-05-15 |
| 1114036092 | Andrew V Beykovsky | Neurological Surgery | 1111 Delafield St Ste 105, Waukesha, WI 53188-3402 | 2006-08-30 |
| 1710093968 | Neurologic Associates of Wisconsin Ltd | Neurological Surgery | 1111 Delafield St Ste 105, Waukesha, WI 53188-3402 | 2006-08-21 |
| 1487663076 | George R. Bartl | Neurological Surgery | 1111 Delafield St Ste 105, Waukesha, WI 53188-3402 | 2006-08-05 |
| 1871502476 | Lynn M. Bartl I | Neurological Surgery | 1111 Delafield St Ste 105, Waukesha, WI 53188-3402 | 2006-08-05 |
| 1619986130 | Kenneth W. Reichert II | Neurological Surgery | 1111 Delafield St Ste 105, Waukesha, WI 53188-3402 | 2006-08-05 |
| 1912950650 | Glenn A Meyer | Neurological Surgery | 1111 Delafield St, Suite 105, Waukesha, WI 53188-3417 | 2006-05-17 |
| 1134198567 | Randy L Gehring | Neurological Surgery | 721 American Ave Ste 108, Waukesha, WI 53188-5071 | 2006-03-17 |
| Find all providers in WAUKESHA | ||||
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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.