Garrett B Anderson, PA
Individual provider Active NPI Physician Assistant · Milwaukee, WI
NPI 1366097420 · NPPES record last updated Nov 19, 2021
Key facts
- NPI
- 1366097420
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 4816-023 (WI)
- Practice address
- 2801 W Kinnickinnic River Pkwy Ste 370
Milwaukee, WI 53215-3678 - Phone
- (414) 649-7900
- NPI assigned
- Aug 6, 2019
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 32
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Aurora Medical Group, Inc.
Lakeshore Medical Clinic LLC
Aurora Advanced Healthcare, Inc.
Practice addresses (Care Compare)
1020 N 12TH St
Milwaukee, WI 53233-1308
Phone (414) 219-3056
200 E Ryan Rd
Oak Creek, WI 53154-4563
Phone (414) 570-3590
2000 E Layton Ave
Saint Francis, WI 53235-6053
Phone (414) 744-6589
2999 N Mayfair Rd
Suite 100
Wauwatosa, WI 53222-4306
Phone (414) 479-7000
3003 W Good Hope Rd
Milwaukee, WI 53209-2042
Phone (414) 352-3100
8901 W Lincoln Ave
West Allis, WI 53227-2409
Phone (414) 329-5950
9000 W Sura LN
Greenfield, WI 53228-3477
Phone (414) 246-6800
945 N 12TH St
Milwaukee, WI 53233-1305
Phone (414) 219-2000
Hospital & facility affiliations
- Aurora St Lukes Medical Center
- West Allis Memorial Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190930001552 | WI | Practitioner - Physician Assistant | 8123358496 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4816-023 | WI | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aurora Medical Group, Inc. | Current |
Accepting new patients | |
| Aurora Advanced Healthcare Inc | Current |
Accepting new patients | |
| Lakeshore Medical Clinic LTD | Current |
Accepting new patients | |
| Aurora Medical Group, Inc. | Current |
Accepting new patients | |
| Lakeshore Medical Clinic, LLC | Current |
Accepting new patients | |
| Aurora Advanced Healthcare, Inc. | Current |
Accepting new patients | |
| Aurora Medical Group, Inc. | Past | 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
2801 W Kinnickinnic River Pkwy
Ste 370
Milwaukee, WI 53215
Phone (414) 649-1280
3301 W Forest Home Ave
Milwaukee, WI 53215
Phone (414) 389-2233
1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056
9000 W Sura Ln
Milwaukee, WI 53228
Phone (414) 246-6500
S74W16775 Janesville Rd
Muskego, WI 53150
Phone (414) 422-4747
2000 E Layton Ave
St Francis, WI 53235
Phone (414) 744-7880
2999 N Mayfair Rd
Wauwatosa, WI 53222
Phone (414) 479-3737
2424 S 90th St
Ste 500
West Allis, WI 53227
Phone (414) 321-2255
Interoperability endpoints
- ganderson223989@direct.myadvocateaurora.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 4816-023 | WI | Yes |
Addresses
Primary practice location
2801 W Kinnickinnic River Pkwy Ste 370
Milwaukee, WI 53215-3678
Mailing address
2801 W Kinnickinnic River Pkwy Ste 370
Milwaukee, WI 53215-3678
Phone (414) 649-7900
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100092798 | Medicaid | WI |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | ganderson223989@direct.myadvocateaurora.org | Direct | |
| FHIR URL | https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/ |
Other providers in Milwaukee, WI
- Denise Anderson
- Diana Lee Anderson
- Diane Elizabeth Anderson
- Elizabeth Anderson
- Eric R Anderson
- Gwen Marie Anderson
- Helen Anderson
- Jeffrey Anderson
- Jeffrey Dean Anderson
- Jeffrey E Anderson
All providers in Milwaukee, WI · Physician Assistant in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 19, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.