Individual provider Active NPI

Gerald L Rhodes, PA-C

  • Physician Assistant
  • Milwaukee, WI
National Provider Identifier
1154355584
Registry record updated Jan 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
300-023 Issued in WI
Practice address
111 E Wisconsin Ave
Milwaukee, WI 53202-4815
Phone
(414) 290-6720
Fax
(414) 290-6755
NPI assigned
Jul 10, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2009

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 300-023 WI Primary

Addresses

Primary practice location

111 E Wisconsin Ave
Milwaukee, WI 53202-4815

Mailing address

111 E Wisconsin Ave
Milwaukee, WI 53202-4815
Phone (414) 290-6720

Other identifiers 2

IdentifierTypeStateIssuer
P00302103OtherWIMEDICARE RAILROAD
42904700MedicaidWI

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
I20050920000233 WI Practitioner - Physician Assistant 9335173319 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Emergency Medicine Specialists SCGroup PAC ID 8729975461, 220 clinicians

Practice addresses (Care Compare)

3329 N Richard St
Appleton, WI 54911-1063
Phone (920) 380-2715

5000 W Chambers St
Milwaukee, WI 53210-1650
Phone (414) 447-2000

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
300WIMDPsychologist
300-023WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Health Dynamics, LLC Physician Assistant Past Accepting new patients
Integrated Therapeutic Massage LLC PastSince Aug 1, 2021 Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1233273600000",
    "number": "1154355584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 E WISCONSIN AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532024815",
            "telephone_number": "414-290-6720",
            "fax_number": "414-290-6755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 E WISCONSIN AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532024815",
            "telephone_number": "414-290-6720",
            "fax_number": "414-290-6755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RHODES",
        "first_name": "GERALD",
        "middle_name": "L",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-10",
        "last_updated": "2009-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "300-023",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00302103",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42904700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.