Individual provider Active NPI

John O'Leary, PA-C

  • Physician Assistant
  • Jackson, WI
National Provider Identifier
1487347928
Registry record updated Jul 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
7492-23 Issued in WI
Practice address
W225N16711 Cedar Park CT
Jackson, WI 53037-9222
Phone
(262) 677-1101
NPI assigned
May 31, 2023
Last updated
Jul 10, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 7492-23 WI Primary

Addresses

Primary practice location

W225N16711 Cedar Park CT
Jackson, WI 53037-9222

Mailing address

W225N16711 Cedar Park CT
Jackson, WI 53037-9222

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20230921003546 WI Practitioner - Physician Assistant 6305290545 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1155 N Mayfair Rd
Wauwatosa, WI 53226-3462
Phone (414) 955-5990

1700 W Paradise Dr
West Bend, WI 53095-9795
Phone (262) 334-3451

2180 S Main St
West Bend, WI 53095-5754
Phone (262) 532-3127

4805 S Moorland Rd
New Berlin, WI 53151-7401
Phone (262) 798-7200

W168N11237 Western Ave
Germantown, WI 53022-3239
Phone (262) 253-5060

W225N16711 Cedar Park CT
Jackson, WI 53037-9222
Phone (262) 677-1101

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
7492-23WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. CurrentSince Aug 11, 2023 Accepting new patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. CurrentSince Aug 11, 2023 Accepting new patients

Locations

W168N11237 Western Ave
Germantown, WI 53022
Phone (262) 253-5060

W225N16711 Cedar Park Ct
Jackson, WI 53037
Phone (262) 323-9257

N74W12501 Leatherwood Ct
Menomonee Falls, WI 53051
Phone (414) 454-4744

1155 N Mayfair Rd
Wauwatosa, WI 53226
Phone (414) 955-5990

Interoperability endpoints

  • Direct secure messaging: jolearyapnpastudent612056@direct.froedtert.com

Organizations & group practices 2

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 2

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": "1685491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688947200000",
    "number": "1487347928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W225N16711 CEDAR PARK CT",
            "city": "JACKSON",
            "state": "WI",
            "postal_code": "530379222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W225N16711 CEDAR PARK CT",
            "city": "JACKSON",
            "state": "WI",
            "postal_code": "530379222",
            "telephone_number": "262-677-1101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'LEARY",
        "first_name": "JOHN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-05-31",
        "last_updated": "2023-07-10",
        "certification_date": "2023-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "7492-23",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, WI

Sources for this page

Verify at the official NPI Registry.