Kevin James Connor, D.D.S., M.D.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

6201 54630 Issued in WI

Practice address

1111 Delafield Street
Suite 222
Waukesha, WI 53188-3403

Phone

(262) 547-8665

Fax

(262) 547-8685

NPI assigned

May 23, 2007

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 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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Maxillofacial Surgery

Education

Louisiana State University School of Medicine in Shreveport, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Oral and Maxillofacial Surgery Associates of Waukesha, LTDGroup PAC ID 0244267227, 8 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Oral and Maxillofacial Surgery Associates of Waukesha, LTD.

  • Oral and Maxillofacial Surgery (Dentist)
  • Waukesha, WI
  • NPI 1235247834
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1279497600000",
    "number": "1174733588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 DELAFIELD STREET",
            "address_2": "SUITE 222",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531883403",
            "telephone_number": "262-547-8665",
            "fax_number": "262-547-8685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 DELAFIELD STREET",
            "address_2": "SUITE 222",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531883403",
            "telephone_number": "262-547-8665",
            "fax_number": "262-547-8685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNOR",
        "first_name": "KEVIN",
        "middle_name": "JAMES",
        "credential": "D.D.S., M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-23",
        "last_updated": "2010-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "LA",
            "license": "S-406",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WI",
            "license": "6201 54630",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07054",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ryan Condon, MS, LCGC
• Alexis Condy, APSW, SAC-IT
• Jonathan M Congdon, MS DVM DACVA
• James F Connelly, M.D.
• Ashley E Conner, APNP
• Michael Scott Connor, D.D.S., M.D.
• Shane Connor, DDS, MD
• Brett Connors, DPT
• Elizabeth Laura Connors, MSN, CNM
• Tajuan Conway, CSAC

• Oral and Maxillofacial Surgery (Dentist) in Waukesha, WI
• Providers in Waukesha, WI by specialty
• Oral and Maxillofacial Surgery (Dentist) in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2010; 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.