NPIMap

Individual provider Active NPI

John George Sanidas, M.D.

  • Internal Medicine Physician
  • Mequon, WI
National Provider Identifier
1356388359
Registry record updated Nov 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
38112 Issued in WI
Practice address
13133 N Port Washington Rd
Suite G-18
Mequon, WI 53097-2419
Phone
(262) 243-5000
Fax
(262) 243-2527
NPI assigned
May 31, 2006
Last updated
Nov 9, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 38112 WI Primary

Addresses

Primary practice location

13133 N Port Washington Rd
Suite G-18
Mequon, WI 53097-2419

Mailing address

788 N Jefferson St
Suite 300/Attn. Kaaren Butzen
Milwaukee, WI 53202-3718
Phone (414) 272-8950

Other identifiers 1

IdentifierTypeStateIssuer
1356388359MedicaidWI

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
I20051114000384 WI Practitioner - Internal Medicine 2769401397 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Medical College of Wisconsin, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Madison Medical Affiliates IncGroup PAC ID 5991606337, 86 clinicians

Practice addresses (Care Compare)

13133 N Port Washington Rd
Suite G 18
Mequon, WI 53097-2420
Phone (262) 243-5000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as apm

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Madison Medical Affiliates, Inc. CurrentSince Jul 1, 1998 Accepting new patients
Columbia St. Mary's Hospital Milwaukee, Inc PastSince Jul 1, 1998 Accepting new patients

Locations

7423 Solutions Ctr
Chicago, IL 60677

13133 N Port Washington Rd
Ste G-18
Mequon, WI 53097
Phone (262) 243-5000

13133 N Port Washington Rd
Ste G01
Mequon, WI 53097
Phone (262) 243-2500

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

788 N Jefferson St
Ste 300ATTN
Milwaukee, WI 53202

788 N Jefferson St
Ste 401
Milwaukee, WI 53202
Phone (414) 226-4020

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/11299/brand/1/csg/1/fhir/r4

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 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478649600000",
    "number": "1356388359",
    "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": "414-272-8950",
            "fax_number": "414-272-0859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13133 N PORT WASHINGTON RD",
            "address_2": "SUITE G-18",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530972419",
            "telephone_number": "262-243-5000",
            "fax_number": "262-243-2527"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANIDAS",
        "first_name": "JOHN",
        "middle_name": "GEORGE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-31",
        "last_updated": "2016-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "38112",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1356388359",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mequon, WI

Sources for this page

Verify at the official NPI Registry.