Active NPI
Kyle McGovern, PHARMD.
- Pharmacist
- Oconomowoc, WI
National Provider Identifier
1083244032
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 16909-40
- Practice address
- 1284 N Summit Ave Ste 100
Oconomowoc, WI 53066-4459 - Phone
- (262) 569-8204
- Fax
- (262) 569-8215
- NPI assigned
- Jan 17, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 16909-40 | WI | Primary |
Addresses
Primary practice location
1284 N Summit Ave Ste 100
Oconomowoc, WI 53066-4459
Mailing address
1284 N Summit Ave Ste 100
Oconomowoc, WI 53066-4459
Phone (262) 569-8204
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16909-40 | WI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aurora Pharmacy, Inc | Past | Accepting new patients | |
| Aurora Pharmacy Inc | Past | Accepting new patients |
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1579219200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1579219200000",
"number": "1083244032",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1284 N SUMMIT AVE STE 100",
"city": "OCONOMOWOC",
"state": "WI",
"postal_code": "530664459",
"telephone_number": "262-569-8204",
"fax_number": "262-569-8215"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1284 N SUMMIT AVE STE 100",
"city": "OCONOMOWOC",
"state": "WI",
"postal_code": "530664459",
"telephone_number": "262-569-8204",
"fax_number": "262-569-8215"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCGOVERN",
"first_name": "KYLE",
"credential": "PHARMD.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-01-17",
"last_updated": "2020-01-17",
"certification_date": "2020-01-17",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "16909-40",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oconomowoc, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.