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SURYA MEDICAL GROUP SC
NPI 1043415631
Family Medicine - Geriatric Medicine in Kenosha, WI

Active since June 15, 2007CLIA 52D0985952 · Waiver
6125 GREEN BAY RD, SUITE 100, KENOSHA, WI 53142(262) 564-8636 Get Directions Write a Review

NPPES record last updated: October 5, 2007. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Surya Medical Group Sc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SURYA MEDICAL GROUP SC (NPI 1043415631) is a healthcare organization registered as a geriatric medicine in Kenosha, Wisconsin and active in the NPI registry since June 2007. The organization holds a CLIA Waiver certificate valid through January 25, 2028 and lists Ganesh N Pulla, Doctor, as its authorized official.

NPPES Registry Identity

NPI1043415631
Entity TypeOrganization
Primary Taxonomy207QG0300X
Legal Business NameSURYA MEDICAL GROUP SC
Location Address6125 GREEN BAY RD, SUITE 100Kenosha, WI 53142-2928
Mailing Address6125 Green Bay Rd, Suite 100Kenosha, WI 53142-2928 · (262) 564-8636
Phone(262) 564-8636
Organization SubpartNo
Authorized OfficialGanesh N PullaDoctor · (262) 564-8636
Enumeration DateJune 15, 2007
Last NPPES UpdateOctober 5, 2007
✔ NPI 1043415631 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyFamily Medicine · Geriatric MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207QG0300X
Definition

A family medicine physician with special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes, and the hospital.

Also ListedInternal Medicine · NephrologyTaxonomy 207RN0300X
6125 GREEN BAY RD, Kenosha, WI 53142
Open in Google Maps ↗

Other Identifiers 1

Medicaid21279800WI

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, CareSource (Common Ground Healthcare), Quartz.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 52D0985952

Surya Medical Group · Kenosha, WI
Active · expires Jan 25, 2028
CLIA Number52D0985952
Laboratory TypePhysician Office
Certificate Effective DateJanuary 26, 2026
Certificate Expiration DateJanuary 25, 2028
Laboratory DirectorGanesh N. Pulla, MD
Laboratory Phone(262) 564-8636
Laboratory LocationSurya Medical Group6125 Green Bay Rd Ste 100, Kenosha, WI 53142
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

GANESH N PULLA M.D
Internal Medicine (Nephrology)
6125 GREEN BAY RD, 100
KENOSHA, WI 53142
Kenosha County (262) 564-8636
DR. LAURIE ANN ROBERTSON O.D.
Optometrist
6125 GREEN BAY RD, SUITE 800
KENOSHA, WI 53142
Kenosha County (262) 654-0726
DR. FRANK SERRECCHIA M.D.
Pediatrics
6125 GREEN BAY RD, SUITE 700
KENOSHA, WI 53142
Kenosha County (262) 654-8633
VICTOR STEPHEN SLANA MD
Ophthalmology
6125 GREEN BAY RD, STE 800
KENOSHA, WI 53142
Kenosha County (262) 654-0726
KIDNEY REPLACEMENT THERAPIES, SC
Clinic/Center (End-Stage Renal Disease (ESRD) Treatment)
6125 GREEN BAY RD, SUITE 100
KENOSHA, WI 53142
Kenosha County (262) 564-8636
KENOSHA KIDNEY DIALYSIS LLC
Clinic/Center (End-Stage Renal Disease (ESRD) Treatment)
6125 GREEN BAY RD, SUITE 100
KENOSHA, WI 53142
Kenosha County (262) 652-1776
BHARATHI PULLA M.D
Family Medicine (Adolescent Medicine)
6125 GREEN BAY RD
KENOSHA, WI 53142
Kenosha County (262) 564-8636
V. STEPHEN SLANA , M.D.,S.C.
Durable Medical Equipment & Medical Supplies
6125 GREEN BAY RD, SUITE 800
KENOSHA, WI 53142
Kenosha County (262) 654-0726

Frequently Asked Questions

What is SURYA MEDICAL GROUP SC's NPI number?

The NPI number assigned to this healthcare provider is 1043415631, enumerated as an "organization" on June 15, 2007.

Where is the provider located?

The provider is located at 6125 GREEN BAY RD SUITE 100 KENOSHA, WI 53142 and the phone number is (262) 564-8636.

What is the provider's specialty?

Family Medicine with taxonomy code 207QG0300X and a focus in Geriatric Medicine.

What insurance does SURYA MEDICAL GROUP SC accept?

The provider might be accepting Accepts: Anthem Blue Cross and Blue Shield, CareSource. Please consult your insurance carrier or call the provider to verify.