Individual provider Active NPI

Peyton Flynn Weber, PA-C

  • Physician Assistant
  • Kenosha, WI
National Provider Identifier
1134093123
Registry record updated Oct 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
8659-23 Issued in WI
Practice address
7401 104TH Ave Ste 110
Kenosha, WI 53142-7845
Phone
(262) 764-5595
Fax
(262) 764-9314
NPI assigned
Oct 2, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 8659-23 WI Primary

Addresses

Primary practice location

7401 104TH Ave Ste 110
Kenosha, WI 53142-7845

Mailing address

7401 104TH Ave Ste 110
Kenosha, WI 53142-7845
Phone (262) 764-5595

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
I20251203000793 WI Practitioner - Physician Assistant 0749773380 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Comprehensive Orthopaedics SCGroup PAC ID 3375445497, 21 clinicians

Practice addresses (Care Compare)

7401 104TH Ave
Suite 110
Kenosha, WI 53142-7845
Phone (262) 764-5595

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
8659-23WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Comprehensive Orthopaedics SC CurrentSince Oct 2, 2025 Accepting new patients
Comprehensive Orthopaedics SC CurrentSince Oct 2, 2025 Accepting new patients

Locations

1757 Milwaukee Ave
#B
Burlington, WI 53105
Phone (262) 764-5595

6804 Green Bay Rd
Ste 108
Kenosha, WI 53142
Phone (262) 697-6323

7401 104th Ave
#110
Kenosha, WI 53142
Phone (262) 764-5595

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: peyton.weber.p1@direct.comportho.nextgenshare.com

Organizations & group practices 2

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": "1759363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759363200000",
    "number": "1134093123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7401 104TH AVE STE 110",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531427845",
            "telephone_number": "262-764-5595",
            "fax_number": "262-764-9314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7401 104TH AVE STE 110",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531427845",
            "telephone_number": "262-764-5595",
            "fax_number": "262-764-9314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEBER",
        "first_name": "PEYTON",
        "middle_name": "FLYNN",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-10-02",
        "last_updated": "2025-10-02",
        "certification_date": "2025-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "8659-23",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kenosha, WI

Sources for this page

Verify at the official NPI Registry.