Individual provider Active NPI

Timothy Kuckuk, AU.D.

  • Audiologist
  • Greenfield, WI
National Provider Identifier
1558848325
Registry record updated Aug 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
672-156 Issued in WI
Practice address
4600 W Loomis Rd
Greenfield, WI 53220-4858
Phone
(414) 281-4466
Fax
(414) 281-4564
NPI assigned
Jul 25, 2018
Last updated
Aug 28, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 672-156 WI Primary

Addresses

Primary practice location

4600 W Loomis Rd
Greenfield, WI 53220-4858

Mailing address

PO Box 735044
Chicago, IL 60673-5044
Phone (800) 326-2250

Other practice location 1

N6444 Riverview Rd
Plymouth, WI 53073-3507
Phone (920) 207-9659

Other identifiers 1

IdentifierTypeStateIssuer
100080974MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address tkuckuk322072@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180919000313 WI Practitioner - Qualified Audiologist 8628329398 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Qualified Audiologist
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians

Practice addresses (Care Compare)

4600 W Loomis Rd
Suite 201
Greenfield, WI 53220-4858
Phone (414) 281-4615

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
672-156WIMDAudiologist

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Advanced Healthcare, Inc. CurrentSince Nov 5, 2021 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Nov 5, 2021 Accepting new patients
Aurora Medical Group, Inc. Audiologist CurrentSince Nov 5, 2021 Accepting new patients
Aurora Advanced Healthcare Inc CurrentSince Nov 5, 2021 Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients

Locations

3003 W Good Hope Rd
Glendale, WI 53209
Phone (414) 352-3100

835 S Van Buren St
Green Bay, WI 54301
Phone (888) 901-7246

12203 N Corporate Pkwy
Mequon, WI 53092
Phone (262) 387-8200

1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056

3301 W Forest Home Ave
Milwaukee, WI 53215
Phone (414) 389-2233

4600 W Loomis Rd
Ste 201
Milwaukee, WI 53220

Interoperability endpoints

  • Direct secure messaging: tkuckuk322072@direct.myadvocateaurora.org

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1532476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724803200000",
    "number": "1558848325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 735044",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606735044",
            "telephone_number": "800-326-2250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4600 W LOOMIS RD",
            "city": "GREENFIELD",
            "state": "WI",
            "postal_code": "532204858",
            "telephone_number": "414-281-4466",
            "fax_number": "414-281-4564"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "N6444 Riverview Rd",
            "address_purpose": "LOCATION",
            "city": "Plymouth",
            "state": "WI",
            "postal_code": "530733507",
            "country_code": "US",
            "telephone_number": "920-207-9659",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KUCKUK",
        "first_name": "TIMOTHY",
        "name_prefix": "Dr.",
        "credential": "AU.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-25",
        "last_updated": "2024-08-28",
        "certification_date": "2024-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "WI",
            "license": "672-156",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100080974",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tkuckuk322072@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "3003 W Good Hope Rd",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532092042",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "3003 W Good Hope Rd",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532092042",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Greenfield, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.