Nickolas Rukamp, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

3493-23 Issued in WI

Practice address

N15W28300 Golf Rd
Pewaukee, WI 53072-4800

Phone

(262) 303-5055

Fax

(262) 303-5057

NPI assigned

Mar 5, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Specialty

Physician Assistant

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Orthopaedic Associates of Wisconsin SCGroup PAC ID 1052200953, 106 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Waukesha Memorial Hospital Hospital, Waukesha, WI, CCN 520008

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Orthopaedic Associates of Wisconsin, SC

  • Orthopaedic Surgery Physician
  • Pewaukee, WI
  • NPI 1689656951
  Medicare reassignment Care Compare group
• Lake Country Emergency Physicians

  • Emergency Medicine Physician
  • Oconomowoc, WI
  • NPI 1720060585
  Medicare reassignment
• Orthopaedic Associates of Wisconsin SC

  • Orthopaedic Surgery Physician
  • Mukwonago, WI
  • NPI 1720433790
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Prohealth Waukesha Memorial Hospital, Inc.

  • General Acute Care Hospital
  • Waukesha, WI
  • NPI 1629056890
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1425513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703116800000",
    "number": "1144613811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6400 INDUSTRIAL LOOP",
            "city": "GREENDALE",
            "state": "WI",
            "postal_code": "531292452",
            "telephone_number": "414-858-4106",
            "fax_number": "414-423-4134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N15W28300 GOLF RD",
            "city": "PEWAUKEE",
            "state": "WI",
            "postal_code": "530724800",
            "telephone_number": "262-303-5055",
            "fax_number": "262-303-5057"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "725 American Ave Ste 5",
            "address_purpose": "LOCATION",
            "city": "Waukesha",
            "state": "WI",
            "postal_code": "531885031",
            "country_code": "US",
            "telephone_number": "262-928-2475",
            "fax_number": "262-544-2198",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUKAMP",
        "first_name": "NICKOLAS",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-03-05",
        "last_updated": "2023-12-21",
        "certification_date": "2023-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WI",
            "license": "3493-23",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100043122",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary Pat Rondinelli
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• Molly Rae Rubel, MS LMFT
• Sabra Wisconsin Operations II, LLC
• Sarita Odessa Salamone, BCTMB, LMT
• Danielle E Sample, PSY.D.
• Jill San Agustin, C.A., MSOM, BS
• Adam Joseph Sangermano, ABOC

• Medical Physician Assistant in Pewaukee, WI
• Providers in Pewaukee, WI by specialty
• Medical Physician Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.