Individual provider Active NPI

Richard Joseph Deklotz, M.D.

  • Anesthesiology Physician
  • Milwaukee, WI
National Provider Identifier
1104169556
Registry record updated Oct 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
62714 Issued in WI
Practice address
4025 N 92ND St
Milwaukee, WI 53222-1613
Phone
(414) 358-5431
Fax
(414) 358-5421
NPI assigned
Apr 4, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 62714 WI Primary

Addresses

Primary practice location

4025 N 92ND St
Milwaukee, WI 53222-1613

Mailing address

4025 N 92ND St
Milwaukee, WI 53222-1613
Phone (414) 358-5431

Other identifiers 1

IdentifierTypeStateIssuer
100039324MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address rdeklotz43426@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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170817002145 WI Practitioner - Anesthesiology 2163741687 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Medical College of Wisconsin, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians

Practice addresses (Care Compare)

975 Port Washington Rd
Grafton, WI 53024-9204
Phone (262) 329-8650

Hospital & facility affiliations

  • Aurora Medical Center - Summit Hospital, Summit, WI, CCN 520206

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
62714WIMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Medical College of Wisconsin, Inc. Anesthesiology CurrentSince Jul 1, 2017 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Aug 21, 2017 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Aug 21, 2017 Accepting new patients
Aurora Medical Group, Inc. Current Accepting new patients

Locations

975 Port Washington Rd
Grafton, WI 53024
Phone (262) 329-1000

3003 University Dr
Marinette, WI 54143
Phone (715) 735-4200

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

36500 Aurora Dr
Summit, WI 53066
Phone (262) 434-1000

4025 N 92nd St
Wauwatosa, WI 53222
Phone (414) 358-5431

8701 Watertown Plank Rd
Wauwatosa, WI 53226
Phone (414) 456-4100

Interoperability endpoints

  • Direct secure messaging: rdeklotz43426@direct.myadvocateaurora.org

Organizations & group practices 4

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.

Hospital & facility affiliations 1

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": "1365033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696896000000",
    "number": "1104169556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4025 N 92ND ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532221613",
            "telephone_number": "414-358-5431",
            "fax_number": "414-358-5421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4025 N 92ND ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532221613",
            "telephone_number": "414-358-5431",
            "fax_number": "414-358-5421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEKLOTZ",
        "first_name": "RICHARD",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-04",
        "last_updated": "2023-10-10",
        "certification_date": "2023-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "WI",
            "license": "62714",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100039324",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rdeklotz43426@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "4025 N 92nd St",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532221613",
            "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": "4025 N 92nd St",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532221613",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.