Individual provider Active NPI

David Mendoza, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Milwaukee, WI
National Provider Identifier
1114364528
Registry record updated May 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
66680-20 Issued in WI
Practice address
9200 W Wisconsin Ave
Milwaukee, WI 53226-3522
Phone
(414) 805-8466
NPI assigned
May 24, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 30, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X TRN18887 FL
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 66680-20 WI Primary

Addresses

Primary practice location

9200 W Wisconsin Ave
Milwaukee, WI 53226-3522

Mailing address

9200 W Wisconsin Ave
Milwaukee, WI 53226-3522
Phone (414) 805-8466

Other practice location 1

9200 W Wisconsin Ave
Milwaukee, WI 53226-3522
Phone (414) 805-8466

Other identifiers 1

IdentifierTypeStateIssuer
1114364528MedicaidWI

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
I20190612000958 WI Practitioner - Pathology 1355674037 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Illinois Gastroenterology Group LLCGroup PAC ID 5193857423, 116 clinicians

Practice addresses (Care Compare)

1415 S Arlington Heights Rd
Arlington Heights, IL 60005-3765
Phone (847) 660-7755

1539 S Waukegan Rd
Waukegan, IL 60085-6727
Phone (847) 549-1312

745 Fletcher Dr
Suite 202
Elgin, IL 60123-4749
Phone (847) 888-1300

Merit-based Incentive Payment System (MIPS)

Final score
84.21 of 100Reported as group
Quality
67.65
Promoting interoperability
99
Improvement activities
40
Cost
80.55

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
TRN18887FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northwest Gastroenterologists SC Current Accepting new patients
Elgin Gastroenterology SC Current Accepting new patients
The Medical College of Wisconsin, Inc. Family Medicine CurrentSince Jun 1, 2019 Accepting new patients
Elgin Gastroenterology Endoscopy Center LLC Current Accepting new patients
Illinois Gastroenterology Group, LLC Anatomic Pathology & Clinical Pathology CurrentSince Sep 1, 2022 Accepting new patients

Locations

745 Fletcher Dr
Ste 202
Elgin, IL 60123
Phone (855) 483-7362

2550 W Algonquin Rd
Lk in the Hls, IL 60156
Phone (847) 458-1246

1539 S Waukegan Rd
Waukegan, IL 60085
Phone (847) 549-1312

9200 W Wisconsin Ave
Wauwatosa, WI 53226
Phone (414) 259-3000

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

Organizations & group practices 5

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": "1369353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559174400000",
    "number": "1114364528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9200 W WISCONSIN AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532263522",
            "telephone_number": "414-805-8466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9200 W WISCONSIN AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532263522",
            "telephone_number": "414-805-8466"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9200 W Wisconsin Ave",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532263522",
            "country_code": "US",
            "telephone_number": "414-805-8466",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MENDOZA",
        "first_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-05-24",
        "last_updated": "2019-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "TRN18887",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "WI",
            "license": "66680-20",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1114364528",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.