Individual provider Active NPI

Breanna M O'Neil, MD

  • Surgery Physician
  • Two Rivers, WI
National Provider Identifier
1407384043
Registry record updated May 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
77378 Issued in WI
Practice address
5000 Memorial Dr
Two Rivers, WI 54241-3900
Phone
(920) 794-5000
NPI assigned
May 26, 2017
Last updated
May 19, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 19, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 77378 WI Primary

Addresses

Primary practice location

5000 Memorial Dr
Two Rivers, WI 54241-3900

Mailing address

5000 Memorial Dr
Two Rivers, WI 54241-3900
Phone (920) 794-5000

Other identifiers 1

IdentifierTypeStateIssuer
100212240MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address boneil346668@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
I20220913003975 WI Practitioner - General Surgery 1951672138 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians

Practice addresses (Care Compare)

5300 Memorial Dr
Two Rivers, WI 54241-3923
Phone (920) 793-7300

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)1-10
Mastectomy1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
373SDMDMechanotherapist
77378WIMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Medical Group, Inc. CurrentSince Aug 29, 2022 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Aug 29, 2022 Accepting new patients
Aurora Health Care North, Inc. Surgery CurrentSince Aug 29, 2022 Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients

Locations

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

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

5000 Memorial Dr
Two Rivers, WI 54241
Phone (920) 794-5000

5300 Memorial Dr
Two Rivers, WI 54241
Phone (920) 793-7300

Organizations & group practices 4

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 1

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": "1495756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684454400000",
    "number": "1407384043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5000 MEMORIAL DR",
            "city": "TWO RIVERS",
            "state": "WI",
            "postal_code": "542413900",
            "telephone_number": "920-794-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5000 MEMORIAL DR",
            "city": "TWO RIVERS",
            "state": "WI",
            "postal_code": "542413900",
            "telephone_number": "920-794-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'NEIL",
        "first_name": "BREANNA",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-26",
        "last_updated": "2023-05-19",
        "certification_date": "2023-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WI",
            "license": "77378",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100212240",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "boneil346668@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "5000 Memorial Dr",
            "city": "Two Rivers",
            "state": "WI",
            "country_code": "US",
            "postal_code": "542413900",
            "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": "5000 Memorial Dr",
            "city": "Two Rivers",
            "state": "WI",
            "country_code": "US",
            "postal_code": "542413900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Two Rivers, WI

Sources for this page

Verify at the official NPI Registry.