NPIMap

Individual provider Active NPI

Mario Kapetsonis, M.D.

  • Family Medicine Physician
  • Milwaukee, WI
National Provider Identifier
1306833991
Registry record updated Jan 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
43438 Issued in WI
Practice address
734 N Jackson St
Milwaukee, WI 53202-4602
Phone
(414) 277-6500
Fax
(414) 224-1365
NPI assigned
Sep 29, 2005
Last updated
Jan 10, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2012

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 43438 WI Primary

Addresses

Primary practice location

734 N Jackson St
Milwaukee, WI 53202-4602

Mailing address

788 N Jefferson St
Suite 300/Attn. Kaaren Butzen
Milwaukee, WI 53202-3718
Phone (414) 274-6271

Other identifiers 1

IdentifierTypeStateIssuer
34283400MedicaidWI

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
I20060331000152 WI Practitioner - Family Practice 1759399843 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

4027 N Oakland Ave
Shorewood, WI 53211-2356
Phone (414) 962-7477

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
43438WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Columbia St. Mary's Hospital Milwaukee, Inc Family Medicine Current Accepting new patients
Columbia St. Mary's Hospital Milwaukee Inc CurrentSince Mar 14, 2006 Accepting new patients
Columbia St. Mary's Hospital Milwaukee Inc CurrentSince Mar 14, 2006 Accepting new patients
Madison Medical Affiliates, Inc. Past Accepting new patients
Columbia St. Mary's Hospital Milwaukee, Inc Family Medicine Past Accepting new patients

Locations

N112W15415 Mequon Rd
Germantown, WI 53022
Phone (262) 250-7800

4425 N Port Washington Rd
Glendale, WI 53212
Phone (414) 326-2218

6900 N Port Washington Rd
Glendale, WI 53217
Phone (414) 270-8100

2323 N Lake Dr
Milwaukee, WI 53211
Phone (414) 291-1000

734 N Jackson St
Milwaukee, WI 53202
Phone (414) 277-6500

788 N Jefferson St
Ste 300ATTN
Milwaukee, WI 53202

830 E Green Bay Ave
Saukville, WI 53080
Phone (262) 284-7117

4027 N Oakland Ave
Shorewood, WI 53211
Phone (414) 319-3080

801 S 70th St
West Allis, WI 53214
Phone (414) 773-6600

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/11299/brand/1/csg/1/fhir/r4
  • Direct secure messaging: ms_mkapetso@landmarkhealth-direct.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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1127952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326153600000",
    "number": "1306833991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "788 N JEFFERSON ST",
            "address_2": "SUITE 300/ATTN. KAAREN BUTZEN",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532023718",
            "telephone_number": "414-274-6271",
            "fax_number": "414-272-0859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "734 N JACKSON ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532024602",
            "telephone_number": "414-277-6500",
            "fax_number": "414-224-1365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAPETSONIS",
        "first_name": "MARIO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-29",
        "last_updated": "2012-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "43438",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34283400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.