Individual provider Active NPI

Stephanie Annakay McElligott, PA-C

  • Physician Assistant
  • Milwaukee, WI
National Provider Identifier
1114214210
Registry record updated Feb 27, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2788-023 Issued in WI
Practice address
2801 W Kinnickinnic River Pkwy
Milwaukee, WI 53215-3669
Phone
(262) 224-1396
NPI assigned
Jul 9, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2788-023 WI Primary
Medical Physician Assistant 363AM0700X 2788-023 WI

Addresses

Primary practice location

2801 W Kinnickinnic River Pkwy
Milwaukee, WI 53215-3669

Mailing address

335 E Gate Dr
Hartford, WI 53027-8318

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111026000883 WI Practitioner - Physician Assistant 2062685670 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

110 Lone Oak LN
Hartford, WI 53027-2600
Phone (262) 670-1800

W168N11237 Western Ave
Germantown, WI 53022-3239
Phone (262) 253-5060

Hospital & facility affiliations

  • St Josephs Community Hospital West Bend Hospital, West Bend, WI, CCN 520063

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2788-023WIMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
The Medical College of Wisconsin, Inc. Current Accepting new patients
DRS. Massaro & Kalenak S C Current Accepting new patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. CurrentSince Apr 19, 2016 Accepting new patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. CurrentSince Apr 19, 2016 Accepting new patients

Locations

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

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

110 Lone Oak Ln
Hartford, WI 53027
Phone (262) 670-1800

840 N 87th St
Wauwatosa, WI 53226
Phone (414) 805-5540

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

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": "1310169600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1393459200000",
    "number": "1114214210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "335 E GATE DR",
            "city": "HARTFORD",
            "state": "WI",
            "postal_code": "530278318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 W KINNICKINNIC RIVER PKWY",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532153669",
            "telephone_number": "262-224-1396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCELLIGOTT",
        "first_name": "STEPHANIE",
        "middle_name": "ANNAKAY",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-09",
        "last_updated": "2014-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "2788-023",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WI",
            "license": "2788-023",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.