NPIMap

Individual provider Active NPI

Jeffrey A Willis, PA

  • Physician Assistant
  • Mequon, WI
National Provider Identifier
1558388520
Registry record updated Dec 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1730 Issued in WI
Practice address
10945 N Port Washington Rd Ste 201
Mequon, WI 53092-5078
Phone
(262) 292-3151
NPI assigned
Jul 16, 2006
Last updated
Dec 10, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2025

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 1730 WI Primary

Addresses

Primary practice location

10945 N Port Washington Rd Ste 201
Mequon, WI 53092-5078

Mailing address

10945 N Port Washington Rd Ste 201
Mequon, WI 53092-5078
Phone (262) 292-3151

Other practice location 1

707 S University Ave
Beaver Dam, WI 53916-3027
Phone (920) 887-7181

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040927001058 WI Practitioner - Physician Assistant 4082683099 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Milwaukee Radiologists LTDGroup PAC ID 7113915810, 16 clinicians

Practice addresses (Care Compare)

10101 S 27TH St
Franklin, WI 53132-7209
Phone (414) 325-4700

3111 W Rawson Ave
Franklin, WI 53132-9417
Phone (414) 325-4300

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1730WIMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
MCHS Hospitals Inc Current Accepting new patients
Beaver Dam Community Hospitals Inc CurrentSince Oct 1, 2025 Accepting new patients
MCHS Hospitals Inc CurrentSince Sep 26, 2025 Accepting new patients
Marshfield Clinic Inc CurrentSince Sep 26, 2025 Accepting new patients
MCHS Hospitals Inc CurrentSince Sep 26, 2025 Accepting new patients
Premier Radiology Wisconsin, LLC Diagnostic Radiology CurrentSince Oct 28, 2023 Accepting new patients
Beaver Dam Community Hospitals Inc CurrentSince Oct 1, 2025 Accepting new patients
Neurological Clinic, SC Past Accepting new patients
Precision Radiology - Illinois LTD Past Accepting new patients

Locations

705 S University Ave
Beaver Dam, WI 53916
Phone (920) 885-6090

707 S University Ave
Beaver Dam, WI 53916
Phone (920) 887-4006

13950 W Capitol Dr
Brookfield, WI 53005
Phone (414) 302-5400

3501 Golf Rd
Eau Claire, WI 54701
Phone (715) 858-4200

1000 N Oak Ave
Marshfield, WI 54449
Phone (715) 387-5111

10180 Washington Ave
Mount Pleasant, WI 53177
Phone (414) 769-4040

3801 Spring St
Mount Pleasant, WI 53405
Phone (262) 636-4011

13111 N Port Washington Rd
Thiensville, WI 53097
Phone (262) 243-7300

201 N Mayfair Rd
Fl 2
Wauwatosa, WI 53226
Phone (414) 771-8228

Organizations & group practices 12

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 4

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": "1153008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765324800000",
    "number": "1558388520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10945 N PORT WASHINGTON RD STE 201",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530925078",
            "telephone_number": "262-292-3151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10945 N PORT WASHINGTON RD STE 201",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530925078",
            "telephone_number": "262-292-3151"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "707 S University Ave",
            "address_purpose": "LOCATION",
            "city": "Beaver Dam",
            "state": "WI",
            "postal_code": "539163027",
            "country_code": "US",
            "telephone_number": "920-887-7181",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "JEFFREY",
        "middle_name": "A",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-16",
        "last_updated": "2025-12-10",
        "certification_date": "2025-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "1730",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mequon, WI

Sources for this page

Verify at the official NPI Registry.