Individual provider Active NPI

Michael D D'Amico, MD

  • Family Medicine Physician
  • Franklin, WI
National Provider Identifier
1386722866
Registry record updated Jun 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
36911 Issued in WI
Practice address
4202 W. Oakwood Park CT
Ste 200
Franklin, WI 53132-8131
Phone
(414) 423-5250
Fax
(414) 423-5256
NPI assigned
Nov 1, 2006
Last updated
Jun 29, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2022

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 36911 WI Primary

Addresses

Primary practice location

4202 W. Oakwood Park CT
Ste 200
Franklin, WI 53132-8131

Mailing address

100-15TH Ave.
Ste. 180
South Milwaukee, WI 53172-1160
Phone (414) 423-5250

Other identifiers 1

IdentifierTypeStateIssuer
32195100MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address mdamico23512@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
I20040701001197 WI Practitioner - Family Practice 7315924966 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Medical College of Wisconsin, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lakeshore Medical Clinic LLCGroup PAC ID 7719890730, 375 clinicians

Practice addresses (Care Compare)

4202 W Oakwood Park CT
Franklin, WI 53132-9118
Phone (414) 423-5250

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
36911WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeshore Medical Clinic, LLC Family Medicine CurrentSince Aug 31, 1996 Accepting new patients
Aurora Advanced Healthcare, Inc. Family Medicine CurrentSince Feb 1, 2017 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Feb 1, 2017 Accepting new patients
Aurora Medical Group, Inc. Family Medicine Current Accepting new patients
Aurora Advanced Healthcare Inc CurrentSince Feb 1, 2017 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Feb 1, 2017 Accepting new patients

Locations

5900 S Lake Dr
Cudahy, WI 53110
Phone (414) 489-4055

4202 W Oakwood Park Ct
Franklin, WI 53132
Phone (414) 421-6002

4202 W Oakwood Park Ct
Ste 200
Franklin, WI 53132
Phone (414) 423-5250

9200 W Loomis Rd
Ste 116
Franklin, WI 53132
Phone (414) 529-9200

3003 W Good Hope Rd
Glendale, WI 53209
Phone (414) 352-3100

12203 N Corporate Pkwy
Mequon, WI 53092
Phone (262) 387-8200

1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056

2801 W Kinnickinnic River Pkwy
Ste 250
Milwaukee, WI 53215
Phone (414) 649-3354

3301 W Forest Home Ave
Milwaukee, WI 53215
Phone (414) 389-2233

S74W16775 Janesville Rd
Muskego, WI 53150
Phone (414) 422-4747

14555 W National Ave
Ste 120
New Berlin, WI 53151
Phone (262) 827-2955

2000 E Layton Ave
St Francis, WI 53235
Phone (414) 744-7880

Interoperability endpoints

  • Direct secure messaging: mdamico23512@direct.myadvocateaurora.org

Organizations & group practices 6

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 6

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": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656460800000",
    "number": "1386722866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100-15TH AVE.",
            "address_2": "STE. 180",
            "city": "SOUTH MILWAUKEE",
            "state": "WI",
            "postal_code": "531721160",
            "telephone_number": "414-423-5250",
            "fax_number": "414-423-5256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4202 W. OAKWOOD PARK CT",
            "address_2": "STE 200",
            "city": "FRANKLIN",
            "state": "WI",
            "postal_code": "531328131",
            "telephone_number": "414-423-5250",
            "fax_number": "414-423-5256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "D'AMICO",
        "first_name": "MICHAEL",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2022-06-29",
        "certification_date": "2022-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "36911",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32195100",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mdamico23512@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "4202 W. Oakwood Park Ct",
            "address_2": "Ste 200",
            "city": "Franklin",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531328131",
            "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": "4202 W. Oakwood Park Ct",
            "address_2": "Ste 200",
            "city": "Franklin",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531328131",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Franklin, WI

Sources for this page

Verify at the official NPI Registry.