WEST BEND CLINIC, INC. (NPI# 1558371104) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558371104 |
| Entity Type | Organization |
| Organization Name | WEST BEND CLINIC, INC. |
| Other Organization Name | WEST BEND CLINIC SOUTH |
| Practice Address |
3200 Pleasant Valley Rd West Bend WI 53095-9274 |
| Mailing Address |
1700 W Paradise Dr West Bend WI 53095-9795 |
| Practice Telephone | 2623343451 |
| Mailing Telephone | 2623343451 |
| Enumeration Date | 2006-08-08 |
| 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 | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians | ||
| N | 207RC0001X |
Internal Medicine Specialization: Clinical Cardiac Electrophysiology |
Allopathic & Osteopathic Physicians | ||
| N | 207RP1001X |
Internal Medicine Specialization: Pulmonary Disease |
Allopathic & Osteopathic Physicians | ||
| N | 207VM0101X |
Obstetrics & Gynecology Specialization: Maternal & Fetal Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians | ||
| N | 208600000X | Surgery | Allopathic & Osteopathic Physicians | ||
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| Y | 207V00000X | Obstetrics & Gynecology | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 21251400 | 05 |
| Other Name | Type Code |
|---|---|
| West Bend Clinic South | 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 |
| 1326057795 | West Bend Clinic, Inc. | Obstetrics & Gynecology | 110 Lone Oak Ln, Hartford, WI 53027-2600 | 2006-08-05 |
| 1235106311 | West Bend Clinic, Inc. | Internal Medicine | 1700 W Paradise Dr, West Bend, WI 53095-9795 | 2006-03-07 |
| Street Address |
3200 PLEASANT VALLEY RD |
| City | WEST BEND |
| State | WI |
| Zip Code | 53095-9274 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568453223 | Ajit B Divgi | Internal Medicine | 3200 Pleasant Valley Rd, Kraemer Cancer Care Center, West Bend, WI 53095-9274 | 2005-11-02 |
| 1992328553 | Elizabeth Dille | Family Medicine | 3200 Pleasant Valley Rd, West Bend, WI 53095-9274 | 2020-05-18 |
| 1407378086 | Amalia A Brouillard | Nurse Practitioner | 3200 Pleasant Valley Rd, West Bend, WI 53095-9274 | 2017-07-14 |
| 1194259291 | Amy Mannes | Occupational Therapist | 3200 Pleasant Valley Rd, West Bend, WI 53095-9274 | 2017-04-14 |
| 1033667688 | Jennifer Esser | Physician Assistant | 3200 Pleasant Valley Rd, West Bend, WI 53095-9274 | 2016-09-12 |
| 1831558113 | Andrea M Pipito | Nurse Practitioner | 3200 Pleasant Valley Rd, West Bend, WI 53095-9274 | 2016-02-16 |
| 1659743318 | Meghan Lynn Christian | Nurse Practitioner | 3200 Pleasant Valley Rd, Pulmonary Diseases, West Bend, WI 53095-9274 | 2015-10-21 |
| 1043699176 | Froedtert & The Medical College of Wisconsin Community Physicians Inc | Clinical Medical Laboratory | 3200 Pleasant Valley Rd, West Bend, WI 53095-9274 | 2015-05-21 |
| 1376935395 | Jessica Anne Held | Nurse Practitioner | 3200 Pleasant Valley Rd, West Bend, WI 53095-9274 | 2015-02-27 |
| 1053759571 | Froedtert & The Medical College of Wisconsin Community Physicians | Durable Medical Equipment & Medical Supplies | 3200 Pleasant Valley Rd, West Bend, WI 53095-9274 | 2013-06-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942820428 | David Fountain | Contractor | 726 Creedwood Lane, West Bend, WI 53095 | 2020-04-24 |
| 1922664358 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1745 South Main St, West Bend, WI 53095 | 2019-05-10 |
| 1912423773 | Michelle R Prentice | Family Medicine | West Bend Health Center, 1700 W. Paradise Drive, West Bend, WI 53095 | 2017-08-14 |
| 1386165918 | Quad/med, LLC | Clinic/Center | 432 E. Washington St. #1115, West Bend, WI 53095 | 2017-07-05 |
| 1508230632 | Jesen Daniel | Counselor | 111 East Washington St, Affiliated Clinical Services, West Bend, WI 53095 | 2015-12-01 |
| 1477965259 | Jenna Crofts | Specialist/Technologist | 1190 East Paradise Drive, West Bend, WI 53095 | 2014-05-28 |
| 1023436342 | Visionworks | Optometrist | 1437 S. Main St., West Bend, WI 53095 | 2014-04-03 |
| 1295157295 | Stephanie Rabe | Registered Nurse | 910 E. Paradise Drive, West Bend, WI 53095 | 2014-01-09 |
| 1477898815 | Ralph Norman Olsen | Pediatrics | 6267 Riesch Road, West Bend, WI 53095 | 2012-12-11 |
| 1932458536 | Joshua Aaron Barta | Dentist | 2090 Continental Drive, West Bend, WI 53095 | 2012-08-29 |
| Find all providers in zip 53095 | ||||
| Taxonomy Code | 207V00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790084002 | Irene Isabel Bozich | Obstetrics & Gynecology | 3200 Pleasant Valley Rd, West Bend, WI 53095-9274 | 2011-03-25 |
| 1487736211 | Elizabeth A Malecha | Obstetrics & Gynecology | 1700 W Paradise Dr, West Bend, WI 53095-9795 | 2006-10-20 |
| 1851473680 | Joel L Jrolf | Obstetrics & Gynecology | 1700 W Paradise Dr, West Bend, WI 53095-9795 | 2006-10-20 |
| 1457431819 | Roxanna Aldstadt | Obstetrics & Gynecology | 3200 Pleasant Valley Rd, Obstetrics and Gynecology, West Bend, WI 53095-9274 | 2006-10-17 |
| 1255354940 | Michelle M. Miller | Obstetrics & Gynecology | 205 Valley Ave, West Bend, WI 53095-5312 | 2006-07-25 |
| 1467494633 | Scott W Donovan | Obstetrics & Gynecology | 1700 W Paradise Dr, West Bend, WI 53095-9795 | 2006-06-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508326562 | Trudy Malone | Obstetrics & Gynecology | N30w29293 Hillcrest Dr, Pewaukee, WI 53072-3235 | 2019-03-24 |
| 1114486990 | Claire Leone Wendland | Obstetrics & Gynecology | 1180 Observatory Dr, Madison, WI 53706-1320 | 2019-03-19 |
| 1407218894 | Caroline Eleonora Bednarski | Obstetrics & Gynecology | 9555 76th St # 4105, Pleasant Prairie, WI 53158-1984 | 2016-03-24 |
| 1992162929 | Hudson Physicians, S.c | Obstetrics & Gynecology | 1617 E Division St Ste 100, River Falls, WI 54022-1571 | 2016-01-21 |
| 1215324439 | Katherine Elizabeth Roberts | Obstetrics & Gynecology | 4655 N Port Washington Rd Ste 100, Glendale, WI 53212-1070 | 2015-04-26 |
| 1063809416 | Tyler Boschuetz | Obstetrics & Gynecology | 19475 W North Ave Ste 400, Brookfield, WI 53045-4199 | 2015-04-23 |
| 1548656168 | Ashley D. Durward | Obstetrics & Gynecology | 5801 Research Park Blvd Ste 400, Madison, WI 53719-6003 | 2015-04-09 |
| 1659766277 | Brandon Kuchta | Obstetrics & Gynecology | 8905 W Lincoln Ave Ste 501, West Allis, WI 53227-2470 | 2015-03-31 |
| 1194125534 | New Womens Care S C | Obstetrics & Gynecology | 855 South Main St., Oconto Falls, WI 54154 | 2014-09-03 |
| 1215348180 | Molly Kathleen Lepic | Obstetrics & Gynecology | 2402 Winnebago St # W, Madison, WI 53704-5341 | 2014-05-14 |
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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.