Active NPI
Mary Jo Zimmer, MD
- Pediatrics Physician
- Milwaukee, WI
National Provider Identifier
1083646236
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 26083
- Practice address
- 3003 W Good Hope Road
Milwaukee, WI 53209 - Phone
- (414) 352-3100
- Fax
- (414) 247-4597
- NPI assigned
- Jul 7, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 26083 | WI | Primary |
Addresses
Primary practice location
3003 W Good Hope Road
Milwaukee, WI 53209
Mailing address
3003 W Good Hope Road
Milwaukee, WI 53209
Phone (414) 352-3100
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30588600 | Medicaid | WI |
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | mzimmer255@direct.myadvocateaurora.org | Direct | |
| FHIR URL | https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060119000686 | WI | Practitioner - Pediatric Medicine | 1658395462 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advanced Healthcare SC | Pediatrics | Past | Accepting new patients |
Interoperability endpoints
- mzimmer255@direct.myadvocateaurora.org
Organizations & group practices 1
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": "1152230400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1638144000000",
"number": "1083646236",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3003 W GOOD HOPE ROAD",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "53209",
"telephone_number": "414-352-3100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3003 W GOOD HOPE ROAD",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "53209",
"telephone_number": "414-352-3100",
"fax_number": "414-247-4597"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZIMMER",
"first_name": "MARY",
"middle_name": "JO",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-07",
"last_updated": "2021-11-29",
"certification_date": "2021-11-29",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "WI",
"license": "26083",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30588600",
"state": "WI"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "mzimmer255@direct.myadvocateaurora.org",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "3003 W Good Hope Road",
"city": "Milwaukee",
"state": "WI",
"country_code": "US",
"postal_code": "53209",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "FHIR",
"endpointTypeDescription": "FHIR URL",
"endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
"affiliation": "N",
"address_1": "3003 W Good Hope Road",
"city": "Milwaukee",
"state": "WI",
"country_code": "US",
"postal_code": "53209",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.