Shawn Michael Sanicola, DPM

Primary specialty

PodiatristTaxonomy code 213E00000X

License

883025 Issued in WI

Practice address

2835 N Grandview Blvd Ste 300
Pewaukee, WI 53072-5591

Phone

(262) 542-3779

Fax

(262) 542-4428

NPI assigned

Jun 16, 2005

Last updated

Feb 16, 2022By 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 3

Addresses

Other identifiers 2

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Podiatry

Education

Kent State University College of Podiatric Medicine, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Foot and Ankle Associates of Wi LTDGroup PAC ID 3779500442, 7 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Waukesha Memorial Hospital Hospital, Waukesha, WI, CCN 520008

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ssanicola9580@direct.phci.org

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.

• Foot and Ankle Associates of Wi LTD

  • Primary Podiatric Medicine Podiatrist
  • Pewaukee, WI
  • NPI 1063534030
  Medicare reassignment Care Compare group NPD
• Affiliated Podiatrists SC

  • Foot & Ankle Surgery Podiatrist
  • Milwaukee, WI
  • NPI 1316994924
  NPD (past)
• Medical Genetics Institute, S.C.

  • Ph.D. Medical Genetics
  • Glendale, WI
  • NPI 1437319142
  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

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

{
    "created_epoch": "1118880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644969600000",
    "number": "1457356305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2835 N GRANDVIEW BLVD",
            "address_2": "STE 300",
            "city": "PEWAUKEE",
            "state": "WI",
            "postal_code": "530725591",
            "telephone_number": "262-542-3779",
            "fax_number": "262-542-4428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2835 N GRANDVIEW BLVD STE 300",
            "city": "PEWAUKEE",
            "state": "WI",
            "postal_code": "530725591",
            "telephone_number": "262-542-3779",
            "fax_number": "262-542-4428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANICOLA",
        "first_name": "SHAWN",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-16",
        "last_updated": "2022-02-16",
        "certification_date": "2022-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "WI",
            "license": "883025",
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "WI",
            "license": "883025",
            "primary": true
        },
        {
            "code": "213ES0000X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Sports Medicine",
            "state": "WI",
            "license": "883025",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI GROUP",
            "identifier": "1316994924",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1457356305",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sabra Wisconsin Operations II, LLC
• Sarita Odessa Salamone, BCTMB, LMT
• Danielle E Sample, PSY.D.
• Jill San Agustin, C.A., MSOM, BS
• Adam Joseph Sangermano, ABOC
• Laurie Jean Sasso, LCSW
• Rosita Saya-Ang
• Marie Schackmuth, PHARMD
• Andrea Elizabeth Schaefer, MS, LPC-IT
• Angela Schmidt, PA-C

• Podiatrist in Pewaukee, WI
• Providers in Pewaukee, WI by specialty
• Podiatrist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2022; 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.