Individual provider Active NPI

Maggie A Weissman, APNP

  • Nurse Practitioner
  • Oconomowoc, WI
National Provider Identifier
1336665082
Registry record updated Oct 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
7890-33 Issued in WI
Practice address
1360 Pabst Farms Cir Ste B
Oconomowoc, WI 53066-4854
Phone
(888) 938-3838
Fax
(888) 919-1083
NPI assigned
Aug 15, 2017
Last updated
Oct 28, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 7890-33 WI Primary

Addresses

Primary practice location

1360 Pabst Farms Cir Ste B
Oconomowoc, WI 53066-4854

Mailing address

10001 W Innovation Dr Ste 200
Milwaukee, WI 53226-4851
Phone (888) 938-3838

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171018000439 WI Practitioner - Nurse Practitioner 6901172048 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1360 Pabst Farms Cir
Suite B
Oconomowoc, WI 53066-4854
Phone (888) 938-3838

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
7890-33WIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Ear Nose & Throat Specialists, SC CurrentSince Nov 1, 2022 Accepting new patients
Advanced Ear Nose & Throat Specialists, SC CurrentSince Nov 1, 2022 Accepting new patients
Prohealth Medical Group Inc Past Accepting new patients

Locations

247 S Nicolet Rd
Appleton, WI 54914

2654 S Oneida St
Stop 102
Green Bay, WI 54304

10610 N Port Washington Rd
Mequon, WI 53092
Phone (262) 923-7879

500 W Drexel Ave
Ste 300
Oak Creek, WI 53154

10001 W Innovation Dr
Ste 200
Wauwatosa, WI 53226

2885 N Mayfair Rd
Wauwatosa, WI 53222
Phone (414) 615-7048

Organizations & group practices 3

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": "1502755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666915200000",
    "number": "1336665082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10001 W INNOVATION DR STE 200",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532264851",
            "telephone_number": "888-938-3838",
            "fax_number": "888-919-1083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1360 PABST FARMS CIR STE B",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530664854",
            "telephone_number": "888-938-3838",
            "fax_number": "888-919-1083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEISSMAN",
        "first_name": "MAGGIE",
        "middle_name": "A",
        "credential": "APNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-15",
        "last_updated": "2022-10-28",
        "certification_date": "2022-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "7890-33",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oconomowoc, WI

Sources for this page

Verify at the official NPI Registry.