Individual provider Active NPI

Antonio Soto

  • Primary Care Nurse Practitioner
  • Wauwatosa, WI
National Provider Identifier
1497400170
Registry record updated Feb 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
11761-33 Issued in WI
Practice address
1155 N Mayfair Rd
Wauwatosa, WI 53226-3462
Phone
(414) 955-5990
NPI assigned
Feb 21, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 11761-33 WI
Primary Care Nurse Practitioner 363LP2300X 11761-33 WI Primary

Addresses

Primary practice location

1155 N Mayfair Rd
Wauwatosa, WI 53226-3462

Mailing address

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

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
I20220627001039 WI Practitioner - Nurse Practitioner 8820477573 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
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

5800 W Layton Ave
Greenfield, WI 53220-4021
Phone (262) 532-3067

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

Hospital & facility affiliations

  • Froedtert Memorial Lutheran Hospital Hospital, Milwaukee, WI, CCN 520177

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
11761-33WIMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. CurrentSince Mar 11, 2022 Accepting new patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. CurrentSince Mar 11, 2022 Accepting new patients

Locations

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

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: asotorn83786@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 and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1645401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645401600000",
    "number": "1497400170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1155 N. MAYFAIR RD.",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "53226",
            "telephone_number": "414-955-5990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1155 N MAYFAIR RD",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532263462",
            "telephone_number": "414-955-5990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOTO",
        "first_name": "ANTONIO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-02-21",
        "last_updated": "2022-02-21",
        "certification_date": "2022-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "11761-33",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "WI",
            "license": "11761-33",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wauwatosa, WI

Sources for this page

Verify at the official NPI Registry.