NPIMap

Individual provider Active NPI

Matthew Mokrohisky, MD

  • Emergency Medicine Physician
  • Wauwatosa, WI
National Provider Identifier
1083978878
Registry record updated Jun 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
63849-20 Issued in WI
Practice address
10625 W North Ave
Suite 102
Wauwatosa, WI 53226-2315
Phone
(414) 877-5351
Fax
(414) 877-5360
NPI assigned
Jun 27, 2012
Last updated
Jun 26, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X TRN17635 FL
Emergency Medicine Physician 207P00000X 63849-20 WI Primary

Addresses

Primary practice location

10625 W North Ave
Suite 102
Wauwatosa, WI 53226-2315

Mailing address

10625 W North Ave
Suite 102
Wauwatosa, WI 53226-2315
Phone (414) 877-5351

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
I20150518000621 WI Practitioner - Emergency Medicine 1557506771 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Wisconsin School of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Emergency Medicine Specialists SCGroup PAC ID 8729975461, 220 clinicians

Practice addresses (Care Compare)

19333 W N Ave
Brookfield, WI 53045-4132
Phone (262) 785-2000

2301 N Lake Dr
Milwaukee, WI 53211-4508
Phone (414) 291-1000

5000 W Chambers St
Milwaukee, WI 53210-1650
Phone (414) 447-2000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
63849-20WIMDEmergency Medicine Physician

Ownership & related parties

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Ascension SE Wisconsin HospitalMilwaukee, WI, CCN 520136 Hospital Corporate Director Jan 1, 2024
Ascension All Saints HospitalRacine, WI, CCN 520096 Hospital Corporate Director Jan 1, 2024
Ascension Sacred Heart Rehabilitation HospitalMequon, WI, CCN 523025 Hospital Corporate Director Jan 1, 2024
Ascension St Francis HospitalMilwaukee, WI, CCN 520078 Hospital Corporate Director Jan 1, 2024
Ascension SE Wisconsin Hospital-Elmbrook CampusBrookfield, WI, CCN 52T136 Hospital Corporate Director Jan 1, 2024
Ascension All Saints HospitalRacine, WI, CCN 52T096 Hospital Corporate Director Jan 1, 2024

Owned or controlled facilities with NPI records 6

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1340755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435276800000",
    "number": "1083978878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10625 W NORTH AVE",
            "address_2": "SUITE 102",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532262315",
            "telephone_number": "414-877-5351",
            "fax_number": "414-877-5360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10625 W NORTH AVE",
            "address_2": "SUITE 102",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532262315",
            "telephone_number": "414-877-5351",
            "fax_number": "414-877-5360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOKROHISKY",
        "first_name": "MATTHEW",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-27",
        "last_updated": "2015-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "FL",
            "license": "TRN17635",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WI",
            "license": "63849-20",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wauwatosa, WI

Sources for this page

Verify at the official NPI Registry.