Individual provider Active NPI

Priti J Patel, MD

  • Family Medicine Physician
  • Kenosha, WI
National Provider Identifier
1205843067
Registry record updated Nov 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
48617 Issued in WI
Practice address
10400 75TH St
Aurora Health Care
Kenosha, WI 53142-7884
Phone
(262) 948-7000
NPI assigned
Aug 2, 2006
Last updated
Nov 17, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 48617 WI Primary

Addresses

Primary practice location

10400 75TH St
Aurora Health Care
Kenosha, WI 53142-7884

Mailing address

PO Box 735044
Chicago, IL 60673-5044
Phone (262) 948-7030

Other identifiers 1

IdentifierTypeStateIssuer
34812600MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address ppatel47627@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, WI2 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

Enrollment IDStateProvider typePAC IDDetails
I20051219000790 IL Practitioner - Family Practice 4183663883 Reassigns benefits to 1 organization
I20060328000548 WI Practitioner - Family Practice 4183663883 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians

Practice addresses (Care Compare)

10400 75TH St
Kenosha, WI 53142-7884
Phone (262) 948-7000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
48617WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeshore Medical Clinic, LLC Family Medicine CurrentSince Dec 5, 2017 Accepting new patients
Aurora Advanced Healthcare, Inc. Family Medicine CurrentSince Dec 5, 2017 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Sep 1, 2007 Accepting new patients
Aurora Medical Group, Inc. Family Medicine Current Accepting new patients
Aurora Advanced Healthcare Inc CurrentSince Dec 5, 2017 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Sep 1, 2007 Accepting new patients
Amg Illinois LTD CurrentSince Dec 5, 2017 Accepting new patients
Amg Illinois LTD Family Medicine CurrentSince Dec 5, 2017 Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients

Locations

45 Tower Ct
Gurnee, IL 60031
Phone (847) 623-3200

7505 Grand Ave
Gurnee, IL 60031
Phone (847) 245-8448

W3985 Highway NN
Elkhorn, WI 53121
Phone (262) 741-2000

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

1726 Shawano Ave
Green Bay, WI 54303
Phone (920) 432-6016

10117 74th St
Ste 110
Kenosha, WI 53142
Phone (262) 697-1919

10400 75th St
Kenosha, WI 53142
Phone (262) 697-7000

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

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

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

S74W16775 Janesville Rd
Muskego, WI 53150
Phone (414) 422-4747

2000 E Layton Ave
St Francis, WI 53235
Phone (414) 744-7880

620 15th Ave
Union Grove, WI 53182
Phone (262) 878-1211

Interoperability endpoints

  • Direct secure messaging: ppatel47627@direct.myadvocateaurora.org

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700179200000",
    "number": "1205843067",
    "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": "262-948-7030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10400 75TH ST",
            "address_2": "AURORA HEALTH CARE",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531427884",
            "telephone_number": "262-948-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATEL",
        "first_name": "PRITI",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-02",
        "last_updated": "2023-11-17",
        "certification_date": "2023-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "48617",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34812600",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ppatel47627@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "10400 75th St",
            "address_2": "Aurora Health Care",
            "city": "Kenosha",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531427884",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "10400 75th St",
            "address_2": "Aurora Health Care",
            "city": "Kenosha",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531427884",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kenosha, WI

Sources for this page

Verify at the official NPI Registry.