Individual provider Active NPI

Scot A Wilfong, DO

  • Family Medicine Physician
  • Port Washington, WI
National Provider Identifier
1306953278
Registry record updated Dec 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
29688 Issued in WI
Practice address
1475 W Grand Ave
Port Washington, WI 53074
Phone
(262) 268-5100
Fax
(262) 268-5118
NPI assigned
Aug 24, 2006
Last updated
Dec 27, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 27, 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 29688 WI Primary

Addresses

Primary practice location

1475 W Grand Ave
Port Washington, WI 53074

Mailing address

PO Box 735044
Chicago, IL 60673-5044
Phone (800) 326-2250

Other identifiers 2

IdentifierTypeStateIssuer
P00774641OtherWIRR MEDICARE
31556500MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address swilfong136@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: 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
I20090908000305 WI Practitioner - Family Practice 2668527086 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Aurora Advanced Healthcare, Inc.Group PAC ID 3375625833, 1,107 clinicians

Practice addresses (Care Compare)

1100 Gateway CT
West Bend, WI 53095-8539
Phone (262) 335-8600

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

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
29688WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Advanced Healthcare, Inc. Family Medicine CurrentSince Aug 1, 2009 Accepting new patients
Aurora Advanced Healthcare Inc CurrentSince Aug 1, 2009 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

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

Interoperability endpoints

  • Direct secure messaging: swilfong136@direct.myadvocateaurora.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.

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": "1156377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703635200000",
    "number": "1306953278",
    "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": "800-326-2250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1475 W GRAND AVE",
            "city": "PORT WASHINGTON",
            "state": "WI",
            "postal_code": "53074",
            "telephone_number": "262-268-5100",
            "fax_number": "262-268-5118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILFONG",
        "first_name": "SCOT",
        "middle_name": "A",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-24",
        "last_updated": "2023-12-27",
        "certification_date": "2023-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "29688",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00774641",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31556500",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "swilfong136@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1475 W Grand Ave",
            "city": "Port Washington",
            "state": "WI",
            "country_code": "US",
            "postal_code": "53074",
            "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": "1475 W Grand Ave",
            "city": "Port Washington",
            "state": "WI",
            "country_code": "US",
            "postal_code": "53074",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Port Washington, WI

Sources for this page

Verify at the official NPI Registry.