Active NPI
Wayne W. Peterson, M.D.
- Family Medicine Physician
- Mukwonago, WI
National Provider Identifier
1538132501
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 27301
- Practice address
- 240 Maple Ave
Mukwonago, WI 53149-8475 - Phone
- (262) 928-1900
- NPI assigned
- Feb 9, 2006
- Last updated
- Oct 19, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 27301 | WI | Primary |
Addresses
Primary practice location
240 Maple Ave
Mukwonago, WI 53149-8475
Mailing address
240 Maple Ave
Mukwonago, WI 53419-8475
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30695400 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 27301 | WI | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aurora Medical Group, Inc. | Past | Accepting new patients | |
| Prohealth Medical Group Inc | Family Medicine | Past | Accepting new patients |
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139443200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1192752000000",
"number": "1538132501",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "240 MAPLE AVE",
"city": "MUKWONAGO",
"state": "WI",
"postal_code": "534198475"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "240 MAPLE AVE",
"city": "MUKWONAGO",
"state": "WI",
"postal_code": "531498475",
"telephone_number": "262-928-1900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "WAYNE",
"middle_name": "W.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-09",
"last_updated": "2007-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WI",
"license": "27301",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30695400",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mukwonago, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.