NPIMap

Individual provider Active NPI

John Derek Lewis, M.D.

  • Diagnostic Radiology Physician
  • Waukesha, WI
National Provider Identifier
1396916656
Registry record updated May 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
55883 Issued in WI
Practice address
W231N1440 Corporate CT
Waukesha, WI 53186-1503
Phone
(262) 896-6000
NPI assigned
Mar 14, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 7, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 036125315 IL
Diagnostic Radiology Physician 2085R0202X 55883 WI Primary

Addresses

Primary practice location

W231N1440 Corporate CT
Waukesha, WI 53186-1503

Mailing address

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

Other practice location 1

2346 Linden Leaf Dr
Glenview, IL 60025-2766
Phone (224) 616-3136

Other identifiers 1

IdentifierTypeStateIssuer
100022915MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/
Direct Messaging Address jlewis395935@direct.myadvocateaurora.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, WI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20110715000623 IL Practitioner - Diagnostic Radiology 1052589199 Reassigns benefits to 2 organizations
I20160119001885 WI Practitioner - Diagnostic Radiology 1052589199 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lakeshore Medical Clinic LLCGroup PAC ID 7719890730, 375 clinicians
Aurora Advanced Healthcare, Inc.Group PAC ID 3375625833, 1,107 clinicians
Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians

Practice addresses (Care Compare)

2000 E Layton Ave
Saint Francis, WI 53235-6053
Phone (414) 744-6589

3003 W Good Hope Rd
Milwaukee, WI 53209-2042
Phone (414) 352-3100

W231 N1440 Corporate Court
Waukesha, WI 53186-1303
Phone (262) 896-6070

Hospital & facility affiliations

  • Aurora St Lukes Medical Center Hospital, Milwaukee, WI, CCN 520138
  • Aurora Medical Center Sheboygan County Hospital, Sheboygan, WI, CCN 520035
  • Aurora Medical Center Kenosha Hospital, Kenosha, WI, CCN 520189
  • West Allis Memorial Hospital Hospital, West Allis, WI, CCN 520139
  • Aurora Medical Center Hospital, Grafton, WI, CCN 520207

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036125315ILMDDiagnostic Radiology Physician
55883WIMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Advanced Healthcare Inc CurrentSince Mar 22, 2024 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Mar 22, 2024 Accepting new patients
Aurora Advanced Healthcare, Inc. CurrentSince Mar 22, 2024 Accepting new patients
Aurora Medical Group, Inc. Diagnostic Radiology CurrentSince Mar 22, 2024 Accepting new patients
Endeavor Health Medical Group CurrentSince Aug 1, 2015 Accepting new patients
Lakeshore Medical Clinic, LLC CurrentSince Mar 22, 2024 Accepting new patients
Endeavor Health Medical Group CurrentSince Aug 1, 2015 Accepting new patients
Ozarks Medical Center Diagnostic Radiology Past Accepting new patients

Locations

9532 Eagle Way
Chicago, IL 60678

2650 Ridge Ave
Ste 2218A
Evanston, IL 60201
Phone (847) 503-4222

2650 Ridge Ave
Evanston, IL 60201
Phone (847) 570-1206

2650 Ridge Ave
Ste G155
Evanston, IL 60201
Phone (847) 570-1600

2650 Ridge Ave
#1223
Evanston, IL 60201
Phone (847) 982-3172

1818 N Meade St
Appleton, WI 54911
Phone (920) 731-4101

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

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

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

W231N1440 Corporate Ct
Waukesha, WI 53186
Phone (262) 896-6000

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 8

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": "1205452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715040000000",
    "number": "1396916656",
    "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": "W231N1440 CORPORATE CT",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531861503",
            "telephone_number": "262-896-6000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2346 Linden Leaf Dr",
            "address_purpose": "LOCATION",
            "city": "Glenview",
            "state": "IL",
            "postal_code": "600252766",
            "country_code": "US",
            "telephone_number": "224-616-3136",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEWIS",
        "first_name": "JOHN",
        "middle_name": "DEREK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-03-14",
        "last_updated": "2024-05-07",
        "certification_date": "2024-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "036125315",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WI",
            "license": "55883",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100022915",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "W231N1440 Corporate Ct",
            "city": "Waukesha",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531861503",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jlewis395935@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "W231N1440 Corporate Ct",
            "city": "Waukesha",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531861503",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Waukesha, WI

Sources for this page

Verify at the official NPI Registry.