NPIMap

Individual provider Active NPI

Justin William Peterson, D.O.

  • Orthopaedic Surgery Physician
  • West Allis, WI
National Provider Identifier
1033558010
Registry record updated Nov 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
71467 Issued in WI
Practice address
2424 S 90TH St
West Allis, WI 53227-2455
Phone
(414) 321-2255
NPI assigned
Jun 23, 2013
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 17, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 71467 WI Primary
Orthopaedic Surgery Physician 207X00000X 5101020737 MI

Addresses

Primary practice location

2424 S 90TH St
West Allis, WI 53227-2455

Mailing address

PO Box 735044
Chicago, IL 60673-5044
Phone (414) 321-2255

Other practice location 1

1 Genesys Pkwy
Grand Blanc, MI 48439-8065
Phone (810) 606-5000

Other identifiers 1

IdentifierTypeStateIssuer
100091524MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190814003398 WI Practitioner - Orthopedic Surgery 0547580185 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Michigan State University College of Osteopathic Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aurora Medical Group, Inc. 3,764 clinicians
Lakeshore Medical Clinic LLC 375 clinicians
Aurora Advanced Healthcare, Inc. 1,107 clinicians

Practice addresses (Care Compare)

1020 N 12TH St
Milwaukee, WI 53233-1308
Phone (414) 219-3056

2000 E Layton Ave
Saint Francis, WI 53235-6053
Phone (414) 744-6589

3003 W Good Hope Rd
Milwaukee, WI 53209-2042
Phone (414) 352-3100

9000 W Sura LN
Greenfield, WI 53228-3477
Phone (414) 246-6800

Hospital & facility affiliations

  • Aurora at Home Home health agency, Milwaukee, WI, CCN 527001
  • West Allis Memorial Hospital Hospital, West Allis, WI, CCN 520139
  • Aurora St Lukes Medical Center Hospital, Milwaukee, WI, CCN 520138
  • Aurora Medical Center Hospital, Grafton, WI, CCN 520207
  • Aurora Medical Center - Summit Hospital, Summit, WI, CCN 520206
  • Aurora Memorial Hospital Burlington Hospital, Burlington, WI, CCN 520059

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement15
Knee replacement12
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10
Upper limb (arm) arthroscopy (minimally invasive joint repair)14
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
71467WIMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Advanced Healthcare, Inc. Orthopaedic Surgery CurrentSince Sep 24, 2023 Accepting new patients
Aspen Orthopaedic and Rehabilitation Specialists S C Orthopaedic Surgery CurrentSince Aug 1, 2019 Accepting new patients
Aurora Medical Group, Inc. CurrentSince May 1, 2023 Accepting new patients
Aurora Medical Group, Inc. CurrentSince May 1, 2023 Accepting new patients
Lakeshore Medical Clinic, LLC CurrentSince Sep 24, 2023 Accepting new patients
Aurora Advanced Healthcare Inc CurrentSince Sep 24, 2023 Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients

Locations

17000 W North Ave
Ste 104W
Brookfield, WI 53005
Phone (262) 395-4141

2205 N Calhoun Rd
Ste 17
Brookfield, WI 53005

3003 W Good Hope Rd
Glendale, WI 53209
Phone (414) 352-3100

835 S Van Buren St
Green Bay, WI 54301
Phone (888) 901-7246

12203 N Corporate Pkwy
Mequon, WI 53092
Phone (262) 387-8200

9000 W Sura Ln
Milwaukee, WI 53228
Phone (414) 246-6500

1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056

S68W15500 Janesville Rd
Muskego, WI 53150
Phone (414) 422-2180

S74W16775 Janesville Rd
Muskego, WI 53150
Phone (414) 422-4747

12555 W National Ave
Ste 100
New Berlin, WI 53151
Phone (262) 395-4141

8907 S Howell Ave
Ste 800
Oak Creek, WI 53154
Phone (262) 395-4141

2000 E Layton Ave
St Francis, WI 53235
Phone (414) 744-7880

2424 S 90th St
Ste 500
West Allis, WI 53227
Phone (414) 321-2255

2424 S 90th St
West Allis, WI 53227
Phone (414) 321-2255

Interoperability endpoints

  • Direct secure messaging: jpeterson255763@direct.myadvocateaurora.org

Organizations & group practices 31

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 31

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1371945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700179200000",
    "number": "1033558010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 735044",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606735044",
            "telephone_number": "414-321-2255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2424 S 90TH ST",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532272455",
            "telephone_number": "414-321-2255"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Genesys Pkwy",
            "address_purpose": "LOCATION",
            "city": "Grand Blanc",
            "state": "MI",
            "postal_code": "484398065",
            "country_code": "US",
            "telephone_number": "810-606-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "JUSTIN",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-06-23",
        "last_updated": "2023-11-17",
        "certification_date": "2023-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "WI",
            "license": "71467",
            "primary": true
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "MI",
            "license": "5101020737",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100091524",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Allis, WI

Sources for this page

Verify at the official NPI Registry.