Samuel James Otto, M.D.

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

19702 Issued in WI

Practice address

2424 S 90TH St
Suite 408
Milwaukee, WI 53227-2455

Phone

(414) 385-2716

NPI assigned

Apr 21, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in UT, TX2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sotto165@yourcarecommunity.org

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.

• Confederated Tribes of the Goshute Reservation

  • General Practice Physician
  • Ibapah, UT
  • NPI 1750510277

  TX

  Medicare reassignment NPD
• Tooele Urology LLC

  • Medical Specialty Clinic/Center
  • South Jordan, UT
  • NPI 1457599912
  Medicare reassignment NPD
• Clinic of Urology SC

  • Urology Physician
  • Milwaukee, WI
  • NPI 1629001342
  NPD
• Deseret Peak Anesthesia, LLC

  • Certified Registered Nurse Anesthetist
  • Tooele, UT
  • NPI 1518972280
  NPD

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

{
    "created_epoch": "1240272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536710400000",
    "number": "1154565273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2376 N 400 E",
            "address_2": "STE A104",
            "city": "TOOELE",
            "state": "UT",
            "postal_code": "840743413",
            "telephone_number": "435-882-0071",
            "fax_number": "435-882-0073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2424 S 90TH ST",
            "address_2": "SUITE 408",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532272455",
            "telephone_number": "414-385-2716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTTO",
        "first_name": "SAMUEL",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-04-21",
        "last_updated": "2018-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "UT",
            "license": "7223921-1205",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "WI",
            "license": "19702",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1154565273",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1154565273",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sarah Elizabeth Otterson, MD
• Alison Alicia Ottman, MA, CCC, SLP
• Mathew Otto
• Paul E Otto, MD
• Richard Otto, M.D.
• Joelle Kathleen Ottoson, MSW, LCSW, ICS,CSAC
• Ayodamola Otun, MD
• Terrance L Otzelberger, PA-C
• Khalil Ouellette, PHARMD
• James Oujiri, M.D.

• Urology Physician in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Urology Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.