Individual provider Active NPI

Mathew Otto

  • Physician Assistant
  • Milwaukee, WI
National Provider Identifier
1194130179
Registry record updated Apr 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
3324-23 Issued in WI
Practice address
2900 W Oklahoma Ave
Milwaukee, WI 53215-4330
Phone
(414) 646-2550
NPI assigned
Jun 27, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2025

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 3324-23 WI Primary

Addresses

Primary practice location

2900 W Oklahoma Ave
Milwaukee, WI 53215-4330

Mailing address

PO Box 735044
Chicago, IL 60673-5044
Phone (414) 646-2550

Other practice location 1

2801 W Kinnickinnic River Pkwy # 3
Milwaukee, WI 53215-3669
Phone (262) 391-5659

Other identifiers 1

IdentifierTypeStateIssuer
100038892MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/
Direct Messaging Address motto98199@direct.myadvocateaurora.org

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
I20140722000282 WI Practitioner - Physician Assistant 3678799020 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aurora Advanced Healthcare, Inc.Group PAC ID 3375625833, 1,107 clinicians

Practice addresses (Care Compare)

12203 N Corporate Pkwy
Mequon, WI 53092-3388
Phone (262) 387-8200

1475 W Grand Ave
Port Washington, WI 53074-2074
Phone (262) 268-5100

Hospital & facility affiliations

  • Aurora Medical Center Hospital, Grafton, WI, CCN 520207
  • Aurora Medical Ctr Washington County Hospital, Hartford, WI, CCN 520038
  • Aurora Medical Center - Summit Hospital, Summit, WI, CCN 520206

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3324-23WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Medical Group, Inc. CurrentSince Jun 30, 2014 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Jun 30, 2014 Accepting new patients
Aurora Advanced Healthcare, Inc. CurrentSince Jun 3, 2024 Accepting new patients
Aurora Advanced Healthcare Inc CurrentSince Jun 3, 2024 Accepting new patients

Locations

3003 W Good Hope Rd
Glendale, WI 53209
Phone (414) 352-3100

N84W16889 Menomonee Ave
Menomonee Fls, WI 53051
Phone (262) 251-7500

12203 N Corporate Pkwy
Mequon, WI 53092
Phone (262) 387-8200

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

2900 W Oklahoma Ave
Milwaukee, WI 53215
Phone (414) 385-2590

2801 W Kinnickinnic River Pkwy
#3
Milwaukee, WI 53215
Phone (262) 391-5659

1475 W Grand Ave
Port Washington, WI 53074
Phone (262) 268-5100

Interoperability endpoints

  • Direct secure messaging: motto98199@direct.myadvocateaurora.org

Organizations & group practices 5

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.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1403827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745971200000",
    "number": "1194130179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 735044",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606735044",
            "telephone_number": "414-646-2550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 W OKLAHOMA AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532154330",
            "telephone_number": "414-646-2550"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2801 W Kinnickinnic River Pkwy # 3",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532153669",
            "country_code": "US",
            "telephone_number": "262-391-5659",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OTTO",
        "first_name": "MATHEW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-27",
        "last_updated": "2025-04-30",
        "certification_date": "2025-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "3324-23",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100038892",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "2801 W Kinnickinnic River Pkwy # 3",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532153669",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "motto98199@direct.myadvocateaurora.org",
            "affiliation": "N",
            "address_1": "2801 W Kinnickinnic River Pkwy # 3",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532153669",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.