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SOUTHERN LAKES ENDOSCOPY LLC
NPI 1851887715
Clinic/Center - Ambulatory Surgical in Mukwonago, WI

Active since July 03, 2018CLIA 52D2161005 · Waiver
240 MAPLE AVE STE 2220, MUKWONAGO, WI 53149(414) 454-0600(414) 454-0971 Get Directions Write a Review

NPPES record last updated: March 19, 2026. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Mar 19, 2026, Jan 8, 2025, May 12, 2020 and 1 more (4 updates tracked since 2018).

About Southern Lakes Endoscopy Llc NPPES

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

SOUTHERN LAKES ENDOSCOPY LLC (NPI 1851887715) is a healthcare organization registered as an ambulatory surgical in Mukwonago, Wisconsin and active in the NPI registry since July 2018. The organization holds a CLIA Waiver certificate valid through January 23, 2027 and lists Amy Jo Burns, Director Revenue Cycle Management, as its authorized official.

NPPES Registry Identity

NPI1851887715
Entity TypeOrganization
Primary Taxonomy261QA1903X
Legal Business NameSOUTHERN LAKES ENDOSCOPY LLC
Location Address240 MAPLE AVE STE 2220Mukwonago, WI 53149-8475
Mailing Address2801 W Kinnickinnic River Pkwy Ste 1080Milwaukee, WI 53215-3689 · (414) 908-6615 · Fax (414) 908-6634
Phone(414) 454-0600
Fax(414) 454-0971
Organization SubpartNo
Authorized OfficialAmy Jo BurnsDirector Revenue Cycle Management · (262) 970-7825
Enumeration DateJuly 3, 2018
Last NPPES UpdateMarch 19, 20264 updates tracked since enumeration
NPPES CertifiedMarch 19, 2026
✔ NPI 1851887715 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Ambulatory SurgicalAmbulatory Health Care Facilities
Taxonomy Code261QA1903X
240 MAPLE AVE STE 2220, Mukwonago, WI 53149
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Network Health, Quartz and more.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 52D2161005

Southern Lakes Endoscopy Center, LLC · Mukwonago, WI
Active · expires Jan 23, 2027
CLIA Number52D2161005
Laboratory TypeAmbulatory Surgery Center
Certificate Effective DateJanuary 24, 2025
Certificate Expiration DateJanuary 23, 2027
Laboratory DirectorDr. William J. Blosky
Laboratory Phone(414) 454-0600
Laboratory LocationSouthern Lakes Endoscopy Center, LLC240 Maple Avenue Suite 2220, Mukwonago, WI 53149
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Areas of Expertise CMS Part B claims 6

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Removal of polyps or growths of large bowel using an endoscope with mechanical snare 45385
This procedure involves using a thin, flexible tube called an endoscope to examine the large bowel. If any abnormal growths or polyps are found, a tool called a mechanical snare is used to remove them. This is a common method to prevent potential health issues.
139 services137 patients
Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope 43239
This procedure involves using a thin, flexible tube with a light and camera, known as an endoscope, to examine the esophagus, stomach, and upper part of the small intestine. Small tissue samples are taken for further examination to help diagnose various conditions.
79 services75 patients
Biopsy of large bowel using a flexible endoscope 45380
A biopsy of the large bowel using a flexible endoscope is a procedure where a thin, flexible tube with a camera is inserted through the rectum to examine the bowel. If abnormal tissue is found, a small sample is taken for further examination. This helps in diagnosing conditions like inflammation, polyps, or cancer.
78 services76 patients
Colorectal cancer screening; colonoscopy on individual at high risk G0105
Colorectal cancer screening, specifically a colonoscopy, is a preventive measure for those at high risk. A thin, flexible tube with a camera inspects the colon to spot any abnormal growths. This test helps detect potential issues early, enhancing the effectiveness of treatment.
46 services46 patients
Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk G0121
Colorectal cancer screening, such as a colonoscopy, is a preventive measure to detect early signs of cancer in the large intestine. For individuals not at high risk, it's typically recommended at age 50. A small, flexible tube with a camera is used to examine your colon. It's a safe, effective way to catch issues early.
23 services23 patients
Diagnostic exam of esophagus, stomach, and/or upper small bowel using a flexible endoscope 43235
This procedure, known as an upper endoscopy, involves inserting a thin, flexible tube with a camera down the throat to examine the esophagus, stomach, and upper small bowel. It helps diagnose conditions like ulcers or inflammation.
18 services17 patients

Frequently 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 Southern Lakes Endoscopy LLC's NPI number?

The NPI number for Southern Lakes Endoscopy LLC is 1851887715. It was assigned to this organization in the NPPES registry on July 3, 2018.

Where is Southern Lakes Endoscopy LLC located?

Southern Lakes Endoscopy LLC is located at 240 Maple Ave Ste 2220, Mukwonago, WI 53149. The listed phone number is (414) 454-0600.

What is Southern Lakes Endoscopy LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Ambulatory Surgical, with taxonomy code 261QA1903X.

Does Southern Lakes Endoscopy LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 52D2161005) is associated with this NPI, valid through January 23, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Southern Lakes Endoscopy LLC accept?

Health plans from Anthem Blue Cross and Blue Shield, Network Health, Quartz and UnitedHealthcare list Southern Lakes Endoscopy LLC 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 Southern Lakes Endoscopy LLC was last updated on March 19, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 months 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.