Ryan Otto

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

8206 Issued in WI

Practice address

1400 43Rd St
Kenosha, WI 53140-2741

Phone

(414) 651-2814

NPI assigned

Jan 30, 2022

Last updated

Mar 16, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL, WI2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Prohealth Medical Group IncGroup PAC ID 3476465188, 475 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Presence Saints Mary and Elizabeth Medical Center Hospital, Chicago, IL, CCN 140180
• Amita Health Resurrection Medical Center Hospital, Chicago, IL, CCN 140117
• Waukesha Memorial Hospital Hospital, Waukesha, WI, CCN 520008

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Prohealth Medical Group Inc.

  • Pediatrics Physician
  • Waukesha, WI
  • NPI 1356322440
  Medicare reassignment Care Compare group NPD
• Primecare Community Health, Inc.

  • Family Medicine Physician
  • Chicago, IL
  • NPI 1558532739
  Medicare reassignment
• Prohealth Medical Group Inc

  • Internal Medicine Physician
  • Watertown, WI
  • NPI 1629119417
  NPD
• Primecare Community Health Inc

  dba Elston

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1891541215
  NPD
• Primecare Community Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1225010911
  NPD
• Primecare Community Health Inc

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1871117937
  NPD (past)
• Primecare Community Health Inc.

  dba PrimeCare Belmont Cragin

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1790247476
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Prohealth Waukesha Memorial Hospital, Inc.

  • General Acute Care Hospital
  • Waukesha, WI
  • NPI 1629056890
  Care Compare affiliation
• Resurrection Medical Center - Chicago LLC

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1811735228
  Care Compare affiliation
• Saint Mary of Nazareth Hospital - Chicago LLC

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1265270607
  Care Compare affiliation

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

{
    "created_epoch": "1643500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773619200000",
    "number": "1457004517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 43RD ST",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531402741",
            "telephone_number": "414-651-2814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 43RD ST",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531402741",
            "telephone_number": "414-651-2814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTTO",
        "first_name": "RYAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-01-30",
        "last_updated": "2026-03-16",
        "certification_date": "2026-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "8206",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "IL",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lynda Orsburn
• Ortho 360 LLC
• Amanda Ann Ortiz, MS, OTR/L
• Paula Michelle Osgood, CRNA
• Emily Otero, APSW
• Suzanne K Otto, DENTAL HYGENIST
• Theresa N Otu, LPC
• Our Future Prenatal LLC
• Becka Owens
• Chyvia L Owens

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2026; 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.