SURYA MEDICAL GROUP SC
NPI 1043415631
Family Medicine - Geriatric Medicine in Kenosha, WI
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
Specialties & Licenses 2
Other Identifiers 1
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Surya Medical Group Sc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Surya Medical Group Sc, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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, WIFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Surya Medical Group Sc's NPI number?
The NPI number for Surya Medical Group Sc is 1043415631. It was assigned to this organization in the NPPES registry on June 15, 2007.
Where is Surya Medical Group Sc located?
Surya Medical Group Sc is located at 6125 Green Bay Rd Suite 100, Kenosha, WI 53142. The listed phone number is (262) 564-8636.
What is Surya Medical Group Sc's specialty?
The primary specialty registered for this NPI is Family Medicine, specializing in Geriatric Medicine, with taxonomy code 207QG0300X.
Is Surya Medical Group Sc enrolled in Medicare?
Yes. Surya Medical Group Sc is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Surya Medical Group Sc?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nephrology) reassigns their Medicare billing to Surya Medical Group Sc. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Surya Medical Group Sc hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 52D0985952) is associated with this NPI, valid through January 25, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Surya Medical Group Sc accept?
Health plans from Anthem Blue Cross and Blue Shield and Quartz list Surya Medical Group Sc as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Surya Medical Group Sc was last updated on October 5, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Surya Medical Group Sc · NPI 1043415631
Geriatric Medicine organization in Kenosha, Wisconsin. Organization record, active in the CMS NPPES registry since June 15, 2007.
## Identity
- **NPI:** 1043415631 (Entity type: Organization)
- **Enumerated:** June 15, 2007
- **Primary specialty:** Family Medicine - Geriatric Medicine · taxonomy 207QG0300X
- **Organization subpart:** No
- **Authorized official:** Ganesh Pulla, DOCTOR
## Practice location
- **Address:** 6125 GREEN BAY RD, SUITE 100, Kenosha, WI 53142-2928
- **Phone:** (262) 564-8636
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Nephrology) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** October 5, 2007
- **Other identifiers:** Medicaid 21279800 (WI)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1043415631) · Data from the CMS NPPES public registry.