DR. MARIO R POWELL (NPI# 1609828391) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609828391 |
| Entity Type | Individual |
| Full Name | DR. MARIO R POWELL |
| Credential | MD |
| Practice Address |
975 Port Washington Rd Division of Neonatology Grafton WI 53024-9201 |
| Practice Telephone | 2623291000 |
| Mailing Telephone | 2623291000 |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2019-09-17 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080N0001X |
Pediatrics Specialization: Neonatal-Perinatal Medicine |
46494 | WI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 1609828391 | 05 | |
| HUMANA | 008906261V | 01 |
| Street Address |
975 PORT WASHINGTON RD DIVISION OF NEONATOLOGY |
| City | GRAFTON |
| State | WI |
| Zip Code | 53024-9201 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942292610 | Robert N. Fish | Anesthesiology | 975 Port Washington Rd, Grafton, WI 53024-9201 | 2005-08-18 |
| 1700499845 | Melissa A Stock | Nurse Practitioner | 975 Port Washington Rd, Grafton, WI 53024-9201 | 2020-08-28 |
| 1689292708 | Scott Thompson | Physical Therapist | 975 Port Washington Rd, Grafton, WI 53024-9201 | 2020-07-07 |
| 1740807296 | Todd R Stanley | Registered Nurse | 975 Port Washington Rd, Grafton, WI 53024-9201 | 2020-07-01 |
| 1639792666 | Emily Ann Feather | Physical Therapist | 975 Port Washington Rd, Grafton, WI 53024-9201 | 2020-05-26 |
| 1073136180 | Jasleen Guru | Physical Therapist | 975 Port Washington Rd, Grafton, WI 53024-9201 | 2020-05-22 |
| 1811517097 | William Knox | Occupational Therapist | 975 Port Washington Rd, Grafton, WI 53024-9201 | 2020-04-17 |
| 1679192314 | Caitlin Marie Hill | Speech-Language Pathologist | 975 Port Washington Rd, Grafton, WI 53024-9204 | 2020-04-13 |
| 1447888789 | Beverly Altman | Massage Therapist | 975 Port Washington Rd, Grafton, WI 53024-9201 | 2020-03-31 |
| 1013540566 | Matthew David Poli | Physician Assistant | 975 Port Washington Rd, Grafton, WI 53024-9201 | 2020-02-12 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245739135 | Kathy Anne Herzog | Counselor | 101 Falls Rd Suite 210, Grafton, WI 53024 | 2018-02-06 |
| 1992215867 | Caroline Marie Brandt | Nurse Practitioner | 975 Port Washington Rd Ste 310, Grafton, WI 53024 | 2017-10-05 |
| 1124569181 | Quirt Family Dentistry, Sc | Dentist | 1580 Port Washington Road, Grafton, WI 53024 | 2017-03-10 |
| 1639626260 | Jennifer Pogodzinski | Physical Therapist | 975 N. Port Washington Avenue, Grafton, WI 53024 | 2016-09-01 |
| 1750790119 | Amanda K Olejniczak | Dentist | 1505 Wisconsin Ave, Ste 130, Grafton, WI 53024 | 2014-08-10 |
| 1992053680 | Liliya Lakshtanov | Registered Nurse | 910 E. Paradise Dr., West Bend, WI 53024 | 2012-08-28 |
| 1467708446 | Trevor Holwell | Pharmacist | 1600 N Port Washington Rd, Grafton, WI 53024 | 2012-07-27 |
| 1770838120 | Brian A. Vetterkind | Physical Therapist | 2225 Wisconsin Ave Ste 100, Grafton, WI 53024 | 2012-07-20 |
| 1366774689 | Tracy Lynn Doro-krueger | Counselor | 1814 Arapaho Court, Grafton, WI 53024 | 2010-02-11 |
| 1659507754 | Karen Marie Geschke | Physical Therapist | 2020 Cheyenne Ct., Grafton, WI 53024 | 2009-06-03 |
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| Taxonomy Code | 2080N0001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Neonatal-Perinatal Medicine |
| A pediatrician who is the principal care provider for sick newborn infants. Clinical expertise is used for direct patient care and for consulting with obstetrical colleagues to plan for the care of mothers who have high-risk pregnancies. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164995494 | Emily Niederhauser | Pediatrics | 675 Highland Ave, Madison, WI 53792-0001 | 2019-01-09 |
| 1831455542 | Adam Steven Bauer | Pediatrics | H6 535 Csc Mailbox 4108, 600 Highland Avenue, Madison, WI 53792 | 2012-04-06 |
| 1831361716 | Janissa Kaye Muller | Pediatrics | 3070 N 51st St # P309, Milwaukee, WI 53210-1645 | 2008-03-31 |
| 1073635157 | Robert Michael Rock Jr. | Pediatrics | 835 S. Vanburen St., Green Bay, WI 54301 | 2007-04-06 |
| 1548393671 | Paul R Myers | Pediatrics | 120 2nd St, Chw-fv, Nicu, Neenah, WI 54956-2883 | 2007-03-14 |
| 1881761971 | Stephen Charles Ragatz | Pediatrics | 3070 N 51st St Ste 309, Suite 309, Milwaukee, WI 53210-1661 | 2006-11-30 |
| 1639264187 | Kyle Owen Mounts | Pediatrics | 3070 North 51st St., Suite P309, Milwaukee, WI 53210-1661 | 2006-10-03 |
| 1427166214 | Ash Mehra | Pediatrics | 635 N 35th St, Milwaukee, WI 53208-3872 | 2006-08-29 |
| 1255448817 | Sahar Katib Kayata | Pediatrics | 3070n.51 St, Ste 309, Milwaukee, WI 53210 | 2006-08-23 |
| 1174639546 | Kevin Eugene Halbert | Pediatrics | 3070 N. 51st Street, Suite P309, Milwaukee, WI 53210-1661 | 2006-08-21 |
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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.