Brad Lyn Hartwig, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1167 Issued in WI

Practice address

11475 N 2ND St
Machesney Park, IL 61115-1285

Phone

(815) 654-8000

NPI assigned

Jun 16, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Physicians Immediate Care North Chicago LLC

  • Urgent Care Clinic/Center
  • Chicago, IL
  • NPI 1205814118
  NPD (past)
• Advanced Pain Management SC

  • Pain Medicine Physician
  • Greenfield, WI
  • NPI 1770506669
  NPD (past)
• Jeffrey G. Bentson, M.D., PLLC

  • Orthopaedic Surgery Physician
  • Port Charlotte, FL
  • NPI 1083850820
  NPD (past)
• Mayo Clinic Health System-Northwest Wisconsin Region, Inc.

  • Critical Access Hospital
  • Bloomer, WI
  • NPI 1700837812
  NPD (past)
• Mayo Clinic Health System-Northwest Wisconsin Region, Inc.

  • Critical Access Hospital
  • Barron, WI
  • NPI 1740239557
  NPD (past)
• Mayo Clinic Health System-Northwest Wisconsin Region, Inc.

  • Critical Access Hospital
  • Osseo, WI
  • NPI 1912958026
  NPD (past)

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

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1200441600000",
    "number": "1477597524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1394 KIWANIS DR APT B302",
            "city": "FREEPORT",
            "state": "IL",
            "postal_code": "610326940",
            "telephone_number": "815-821-4777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11475 N 2ND ST",
            "city": "MACHESNEY PARK",
            "state": "IL",
            "postal_code": "611151285",
            "telephone_number": "815-654-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARTWIG",
        "first_name": "BRAD",
        "middle_name": "LYN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-16",
        "last_updated": "2008-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "1167",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085-002982",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42988500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Allison Renee Geissman, COTA/L
• Bryce Thomas Goodall
• Lorraine Graham
• Ashley A. Grover, DPT
• Harlem School Dist 122
• Healthstat on-Site Clinic/Parker Hannifin Rockford
• Yingsu Her, D.C.
• Shahalonie Herman
• Christian Daniel Hernandez, OD
• Highland Park CVS LLC

• Physician Assistant in Machesney Park, IL
• Providers in Machesney Park, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.