NPIMap

Individual provider Active NPI

Jaswinder Sidhu, M.D.

  • Internal Medicine Physician
  • Oconomowoc, WI
National Provider Identifier
1073628509
Registry record updated Mar 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
40698 Issued in WI
Practice address
1085 Corporate Center Dr
Suite 175
Oconomowoc, WI 53066-4845
Phone
(262) 928-8400
Fax
(262) 928-8484
NPI assigned
Aug 21, 2006
Last updated
Mar 22, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 40698 WI Primary

Addresses

Primary practice location

1085 Corporate Center Dr
Suite 175
Oconomowoc, WI 53066-4845

Mailing address

1085 Corporate Center Dr
Suite 175
Oconomowoc, WI 53066-4845
Phone (262) 928-8400

Other identifiers 1

IdentifierTypeStateIssuer
34323900MedicaidWI

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
I20100129000344 WI Practitioner - Internal Medicine 7517000516 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Oak Medical SCGroup PAC ID 0042595175, 118 clinicians

Practice addresses (Care Compare)

18740 W Bluemound Rd
Brookfield, WI 53045-2936
Phone (262) 782-0230

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
40698WIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Maple Medical SC Internal Medicine CurrentSince Oct 31, 2019 Accepting new patients
Oak Medical SC Internal Medicine CurrentSince Feb 1, 2018 Accepting new patients
Prohealth Medical Group Inc Internal Medicine Past Accepting new patients

Locations

18740 W Bluemound Rd
Brookfield, WI 53045
Phone (262) 782-0230

2428 N Grandview Blvd
Ste 102
Waukesha, WI 53188
Phone (262) 875-5070

N20W22961 Watertown Rd
Waukesha, WI 53186
Phone (262) 875-5070

Organizations & group practices 3

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

Hospital & facility affiliations 9

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": "1156118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1458604800000",
    "number": "1073628509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1085 CORPORATE CENTER DR",
            "address_2": "SUITE 175",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530664845",
            "telephone_number": "262-928-8400",
            "fax_number": "262-928-8484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1085 CORPORATE CENTER DR",
            "address_2": "SUITE 175",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530664845",
            "telephone_number": "262-928-8400",
            "fax_number": "262-928-8484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIDHU",
        "first_name": "JASWINDER",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-21",
        "last_updated": "2016-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "40698",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34323900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oconomowoc, WI

Sources for this page

Verify at the official NPI Registry.