NPIMap

Individual provider Active NPI

Kevin Scott Packman, MD

  • Surgery Physician
  • Milwaukee, WI
National Provider Identifier
1437159399
Registry record updated Mar 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
33416 Issued in WI
Practice address
5150 N Port Washington Rd
Suite 151
Milwaukee, WI 53217-5474
Phone
(414) 332-1000
Fax
(414) 332-1005
NPI assigned
Jul 21, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2008

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 33416 WI Primary
Vascular Surgery Physician 2086S0129X 33416 WI

Addresses

Primary practice location

5150 N Port Washington Rd
Suite 151
Milwaukee, WI 53217-5474

Mailing address

5150 N Port Washington Rd
Suite 151
Milwaukee, WI 53217-5474
Phone (414) 332-1000

Other identifiers 1

IdentifierTypeStateIssuer
32705400MedicaidWI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080709000061 WI Practitioner - General Surgery 8527060615 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Wayne State University School of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

201 N Mayfair Rd
Wauwatosa, WI 53226-4216

2311 N Prospect Ave
Milwaukee, WI 53211-4445
Phone (414) 319-3000

4655 N Port Washington Rd
Suite 100
Glendale, WI 53212-1070
Phone (414) 961-7444

9969 S 27TH St
Franklin, WI 53132-9533
Phone (414) 325-4940

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Leg revascularization (restoring blood flow)1-10
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
33416WIMDVascular Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ascension Medical Group-Southeast Wisconsin Inc Vascular Surgery CurrentSince Sep 1, 2008 Accepting new patients
Columbia St. Mary's Hospital Milwaukee Inc CurrentSince May 20, 2018 Accepting new patients
Columbia St. Mary's Hospital Milwaukee, Inc Current Accepting new patients
Columbia St. Mary's Hospital Milwaukee, Inc CurrentSince May 20, 2018 Accepting new patients
Columbia St. Mary's Hospital Milwaukee, Inc Past Accepting new patients
DRS Wagner Goodman Pasch and Packman LTD Surgery Past Accepting new patients
Vascular Laboratory Associates Vascular Surgery Past Accepting new patients
Ascension All Saints Hospital, Inc Past Accepting new patients

Locations

13950 W Capitol Dr
Brookfield, WI 53005
Phone (414) 302-5400

5150 N Port Washington Rd
Ste 151
Glendale, WI 53217
Phone (414) 332-1000

5000 W Chambers St
Milwaukee, WI 53210
Phone (414) 447-2089

2350 N Lake Dr
Ste 100
Milwaukee, WI 53211
Phone (414) 298-7250

2311 N Prospect Ave
Milwaukee, WI 53211
Phone (414) 319-3000

9252 N Green Bay Rd
Milwaukee, WI 53209
Phone (414) 527-5089

201 N Mayfair Rd
Fl 2
Wauwatosa, WI 53226
Phone (414) 771-8228

801 S 70th St
West Allis, WI 53214
Phone (414) 773-6600

Organizations & group practices 8

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 3

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": "1121904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1205798400000",
    "number": "1437159399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5150 N PORT WASHINGTON RD",
            "address_2": "SUITE 151",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532175474",
            "telephone_number": "414-332-1000",
            "fax_number": "414-332-1005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5150 N PORT WASHINGTON RD",
            "address_2": "SUITE 151",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532175474",
            "telephone_number": "414-332-1000",
            "fax_number": "414-332-1005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PACKMAN",
        "first_name": "KEVIN",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-21",
        "last_updated": "2008-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WI",
            "license": "33416",
            "primary": true
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "WI",
            "license": "33416",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32705400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.