Michael L Douglass, AA – Anesthesiologist Assistant

Key facts

NPI: 1154070738
Entity type: Individual (NPI type 1)
Primary specialty: Anesthesiologist Assistant 367H00000X
License: 209-17 (WI)
Practice address: 36500 Aurora Dr
Summit, WI 53066-4899
Phone: (262) 434-1000
NPI assigned: Mar 22, 2022
Sex: Male
Sole proprietor: No

Organizations & group practices 3

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.

Aurora Medical Group, Inc. Certified Registered Nurse Anesthetist · Milwaukee, WI · NPI 1427271378

Medicare reassignment NPD WI
Aurora Medical Group, Inc. Durable Medical Equipment & Medical Supplies · Oshkosh, WI · NPI 1326858044

NPD
Aurora Medical Group, Inc. Mental Health Clinic/Center (Including Community Mental Health Center) · Milwaukee, WI · NPI 1659599157

NPD

Hospital & facility affiliations 1

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

Aurora Health Care Southern Lakes, Inc. General Acute Care Hospital · Summit, WI · NPI 1699008029

Care Compare affiliation Hospital

Medicare Care Compare profile

Specialty: Anesthesiology Assistant
Education: Indiana University School of Medicine, 2021
Medicare assignment: Accepts the Medicare-approved amount as payment in full
Group practices: Aurora Medical Group, Inc. (3,764 clinicians)

Practice addresses (Care Compare)

36500 Aurora Dr
Summit, WI 53066-4899
Phone (262) 434-5000

Hospital & facility affiliations

Aurora Medical Center - Summit Hospital · Summit, WI · CCN 520206

Medicare participation

Medicare fee-for-service enrollment: Enrolled in WI

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20220401001575	WI	Practitioner - Anesthesiology Assistant	8022404961	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Associate of Arts

State licenses

License	State	Type	Specialty
209-17	WI	MD	Anesthesiologist Assistant

Practice roles

Organization	Status	New patients
Aurora Medical Group, Inc.	Current since Apr 1, 2022	Accepting new patients
Aurora Medical Group, Inc.	Current since Apr 1, 2022	Accepting new patients
Aurora Medical Group, Inc.	Current	Accepting new patients

Locations

1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056

3301 W Forest Home Ave
Milwaukee, WI 53215
Phone (414) 389-2233

36500 Aurora Dr
Summit, WI 53066
Phone (262) 434-1000

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Anesthesiologist Assistant	367H00000X	209-17	WI	Yes

Addresses

Primary practice location

36500 Aurora Dr
Summit, WI 53066-4899

Mailing address

36500 Aurora Dr
Summit, WI 53066-4899
Phone (262) 434-1000

Electronic endpoints

Type	Endpoint	Use	Affiliation
FHIR URL	https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/
Direct Messaging Address	mdouglass333180@direct.myadvocateaurora.org	Direct

Other providers in Summit, WI

All providers in Summit, WI · Anesthesiologist Assistant in Wisconsin

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 14, 2022. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Medicare Care Compare provider data (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.