Gwen Joyce Gettelman, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1219-023 Issued in WI

Practice address

10303 N Port Washington Rd
Suite 101
Mequon, WI 53092-5760

Phone

(262) 240-0440

Fax

(262) 240-0441

NPI assigned

Jul 28, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 3

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Forefront Dermatology SCGroup PAC ID 3779471701, 650 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

97.45 of 100Reported as group

Promoting interoperability

97

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Forefront Dermatology, S.C.

  • Dermatology Physician
  • Appleton, WI
  • NPI 1083768253
  Medicare reassignment Care Compare group
• Forefront Dermatology, S.C.

  • Dermatology Physician
  • Glendale, WI
  • NPI 1245506971
  NPD
• Forefront Dermatology, S.C.

  • Dermatology Physician
  • Columbus, OH
  • NPI 1063365385
  NPD
• Forefront Dermatology, S.C.

  • Dermatology Physician
  • Manitowoc, WI
  • NPI 1578515904
  NPD (past)
• North Shore Dermatology, S.C.

  • Dermatology Physician
  • Mequon, WI
  • NPI 1649399080
  NPD (past)

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675900800000",
    "number": "1427062835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 YORK ST",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542204630",
            "telephone_number": "920-663-9008",
            "fax_number": "920-684-1439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10303 N PORT WASHINGTON RD",
            "address_2": "SUITE 101",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530925760",
            "telephone_number": "262-240-0440",
            "fax_number": "262-240-0441"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7040 N Port Washington Rd Ste 404",
            "address_purpose": "LOCATION",
            "city": "Glendale",
            "state": "WI",
            "postal_code": "532173885",
            "country_code": "US",
            "telephone_number": "414-355-2405",
            "fax_number": "414-355-6460",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2600 N Mayfair Rd Ste 810",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532261328",
            "country_code": "US",
            "telephone_number": "414-771-1122",
            "fax_number": "414-771-1352",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GETTELMAN",
        "first_name": "GWEN",
        "middle_name": "JOYCE",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-28",
        "last_updated": "2023-02-09",
        "certification_date": "2023-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "1219-023",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Gwen.Gettelman@forefrontdermatology.emadirect.md",
            "affiliation": "N",
            "address_1": "2600 N Mayfair Rd Ste 810",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532261328",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Gwen.Gettelman@forefrontdermatology.emadirect.md",
            "affiliation": "N",
            "address_1": "10303 N Port Washington Rd",
            "address_2": "Suite 101",
            "city": "Mequon",
            "state": "WI",
            "country_code": "US",
            "postal_code": "530925760",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Gwen.Gettelman@forefrontdermatology.emadirect.md",
            "affiliation": "N",
            "address_1": "7040 N Port Washington Rd Ste 404",
            "city": "Glendale",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532173885",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Genesis Adult Family Home LLC
• Genufeet, Inc (Foot Solutions of Mequon)
• Michael Gerard, MD
• Rachel Gerber
• Mark E German, O.D.
• Mena Ghaly, D.D.S
• Hutan Ghojallu, D.C.
• Paul M Gibeau, PSYD
• Danyale Giemza
• Erin Giese

• Physician Assistant in Mequon, WI
• Providers in Mequon, WI by specialty
• Physician Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.