Individual provider Active NPI

Jose Mariano Cabrera, M.D.

  • Pediatric Gastroenterology Physician
  • Milwaukee, WI
National Provider Identifier
1235330721
Registry record updated Jun 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X
License
57271 Issued in WI
Practice address
9000 W Wisconsin Ave
Milwaukee, WI 53226-4874
Phone
(414) 266-3690
Fax
(414) 266-3676
NPI assigned
May 30, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 01067035A IN
Pediatric Gastroenterology Physician 2080P0206X 57271 WI Primary

Addresses

Primary practice location

9000 W Wisconsin Ave
Milwaukee, WI 53226-4874

Mailing address

9000 W Wisconsin Ave
Milwaukee, WI 53226-4874
Phone (414) 266-3690

Other practice location 1

2575 E Evergreen Drive
Appleton, WI 54913-8904
Phone (920) 969-5353

Other practice location 2

1506 S Oneida St Ste 500
Appleton, WI 54915-1305
Phone (920) 738-2000

Other practice location 3

702 Barnhill Dr
Room 1740-G
Indianapolis, IN 46202-5128
Phone (317) 274-3774

Other identifiers 1

IdentifierTypeStateIssuer
1235330721MedicaidWI

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120718000554 WI Practitioner - GastroenterologyPractitioner - Pediatric Medicine 6305002460 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01067035AINMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Medical College of Wisconsin, Inc. CurrentSince Aug 1, 2012 Accepting new patients
Children's Specialty Group, Inc. Pediatrics Past Accepting new patients

Locations

1506 S Oneida St
Ste 500
Appleton, WI 54915
Phone (920) 738-8050

1506 S Oneida St
Appleton, WI 54915
Phone (920) 730-4950

10911 N Port Washington Rd
Mequon, WI 53092
Phone (262) 241-2080

Bin 88350
Milwaukee, WI 53288
Phone (414) 805-3122

1601 N Taylor Dr
Sheboygan, WI 53081
Phone (920) 459-4767

9000 W Wisconsin Ave
Wauwatosa, WI 53226
Phone (414) 266-2625

8701 Watertown Plank Rd
Wauwatosa, WI 53226
Phone (414) 456-4100

Interoperability endpoints

  • Direct secure messaging: jcabrera13400@direct.chw.org

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686614400000",
    "number": "1235330721",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9000 W WISCONSIN AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532264874",
            "telephone_number": "414-266-3690",
            "fax_number": "414-266-3676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9000 W WISCONSIN AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532264874",
            "telephone_number": "414-266-3690",
            "fax_number": "414-266-3676"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2575 E Evergreen Drive",
            "address_purpose": "LOCATION",
            "city": "Appleton",
            "state": "WI",
            "postal_code": "549138904",
            "country_code": "US",
            "telephone_number": "920-969-5353",
            "fax_number": "414-337-7201",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1506 S Oneida St Ste 500",
            "address_purpose": "LOCATION",
            "city": "Appleton",
            "state": "WI",
            "postal_code": "549151305",
            "country_code": "US",
            "telephone_number": "920-738-2000",
            "fax_number": "414-266-3676",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "702 Barnhill Dr",
            "address_2": "Room 1740-G",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462025128",
            "country_code": "US",
            "telephone_number": "317-274-3774",
            "fax_number": "317-274-8521",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CABRERA",
        "first_name": "JOSE",
        "middle_name": "MARIANO",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-30",
        "last_updated": "2023-06-13",
        "certification_date": "2023-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IN",
            "license": "01067035A",
            "primary": false
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "WI",
            "license": "57271",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1235330721",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.