NPIMap

Individual provider Active NPI

Jacob Tait Demaster, D.O.

  • Family Medicine Physician
  • Sheboygan, WI
National Provider Identifier
1215373147
Registry record updated Nov 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5101020370 Issued in MI
Practice address
1813 Ashland Ave
Sheboygan, WI 53081-6125
Phone
(920) 458-4010
NPI assigned
May 19, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2021

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 5101020370 MI Primary

Addresses

Primary practice location

1813 Ashland Ave
Sheboygan, WI 53081-6125

Mailing address

1813 Ashland Ave
Sheboygan, WI 53081-6125
Phone (920) 458-4010

Other identifiers 1

IdentifierTypeStateIssuer
100058168MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address jdemaster177648@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 WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160816001713 WI Practitioner - Family Practice 3779892914 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Chicago, Pritzker School of Medicine, 2013
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)

1813 Ashland Ave
Sheboygan, WI 53081-6125
Phone (920) 458-4010

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeshore Medical Clinic, LLC Family Medicine CurrentSince Jun 1, 2023 Accepting new patients
Aurora Medical Group, Inc. Family Medicine CurrentSince Aug 1, 2016 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Aug 1, 2016 Accepting new patients
Aurora Advanced Healthcare, Inc. Family Medicine CurrentSince Jun 1, 2023 Accepting new patients
Aurora Advanced Healthcare Inc CurrentSince Jun 1, 2023 Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients

Locations

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

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

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

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

200 E Ryan Rd
Oak Creek, WI 53154
Phone (414) 570-3590

1813 Ashland Ave
Sheboygan, WI 53081
Phone (920) 458-4010

1146 Plankview Green Blvd
Sheboygan Falls, WI 53085
Phone (920) 457-2424

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

Organizations & group practices 6

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 9

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": "1368921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638230400000",
    "number": "1215373147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1813 ASHLAND AVE",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "530816125",
            "telephone_number": "920-458-4010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1813 ASHLAND AVE",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "530816125",
            "telephone_number": "920-458-4010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEMASTER",
        "first_name": "JACOB",
        "middle_name": "TAIT",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-05-19",
        "last_updated": "2021-11-30",
        "certification_date": "2021-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101020370",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100058168",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jdemaster177648@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1813 Ashland Ave",
            "city": "Sheboygan",
            "state": "WI",
            "country_code": "US",
            "postal_code": "530816125",
            "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": "1813 Ashland Ave",
            "city": "Sheboygan",
            "state": "WI",
            "country_code": "US",
            "postal_code": "530816125",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Sheboygan, WI

Sources for this page

Verify at the official NPI Registry.