NPIMap

Individual provider Active NPI

Henok Desta Hardilo, MD

  • Internal Medicine Physician
  • Menomonee Falls, WI
National Provider Identifier
1104454750
Registry record updated Aug 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
76461 Issued in WI
Practice address
W180N8085 Town Hall Rd
Menomonee Falls, WI 53051-3518
Phone
(262) 257-2447
NPI assigned
Mar 30, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2023

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
Internal Medicine Physician 207R00000X 76461 WI Primary

Addresses

Primary practice location

W180N8085 Town Hall Rd
Menomonee Falls, WI 53051-3518

Mailing address

W180N8085 Town Hall Rd
Menomonee Falls, WI 53051-3518
Phone (262) 257-2447

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, NC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230901000412 WI Practitioner - Internal Medicine 9830552215 Reassigns benefits to 2 organizations
I20241214000311 NC Practitioner - HospitalistPractitioner - Internal Medicine 9830552215 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

W180N8000 Town Hall Rd
Menomonee Falls, WI 53051-4002
Phone (262) 255-2500

Hospital & facility affiliations

  • Horizon Homecare and Hospice Hospice, Milwaukee, WI, CCN 521531
  • Community Memorial Hospital Hospital, Menomonee Falls, WI, CCN 520103
  • St Josephs Community Hospital West Bend Hospital, West Bend, WI, CCN 520063
  • Froedtert Community Hospital Hospital, New Berlin, WI, CCN 520213
  • Froedtert Memorial Lutheran Hospital Hospital, Milwaukee, WI, CCN 520177

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
76461WIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Froedtert Manitowoc Medical Group, LLC Internal Medicine CurrentSince Jun 1, 2024 Accepting new patients
Carolinas Physicians Network Inc CurrentSince Oct 7, 2024 Accepting new patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. CurrentSince Aug 11, 2023 Accepting new patients
Carolinas Physicians Network Inc Internal Medicine CurrentSince Oct 7, 2024 Accepting new patients
Carolinas Physicians Network Inc Current Accepting new patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. Internal Medicine CurrentSince Aug 11, 2023 Accepting new patients

Locations

1000 Blythe Blvd
Charlotte, NC 28203
Phone (704) 351-3791

W168N11237 Western Ave
Germantown, WI 53022
Phone (262) 253-5060

2300 Western Ave
Manitowoc, WI 54220
Phone (920) 320-2011

N74W12501 Leatherwood Ct
Menomonee Falls, WI 53051
Phone (414) 454-4744

W180N8000 Town Hall Rd
Menomonee Falls, WI 53051
Phone (262) 255-2500

W180N8085 Town Hall Rd
Menomonee Fls, WI 53051
Phone (262) 257-5000

1414 N Taylor Dr
Sheboygan, WI 53081
Phone (920) 320-2011

1155 N Mayfair Rd
Wauwatosa, WI 53226
Phone (414) 955-5990

Interoperability endpoints

  • Direct secure messaging: hhardilo590978@direct.froedtert.com
  • Direct secure messaging: hhardilo2906753@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 6

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 8

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": "1585526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691971200000",
    "number": "1104454750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W180N8085 TOWN HALL RD",
            "city": "MENOMONEE FALLS",
            "state": "WI",
            "postal_code": "530513518",
            "telephone_number": "262-257-2447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W180N8085 TOWN HALL RD",
            "city": "MENOMONEE FALLS",
            "state": "WI",
            "postal_code": "530513518",
            "telephone_number": "262-257-2447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARDILO",
        "first_name": "HENOK",
        "middle_name": "DESTA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-30",
        "last_updated": "2023-08-14",
        "certification_date": "2023-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "76461",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Menomonee Falls, WI

Sources for this page

Verify at the official NPI Registry.