Individual provider Active NPI

William P Mustas, P.A.

  • Physician Assistant
  • Waukesha, WI
National Provider Identifier
1629080932
Registry record updated Sep 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1307 Issued in WI
Practice address
1111 Delafield St Ste 215
Waukesha, WI 53188-3403
Phone
(262) 542-0074
Fax
(262) 542-2803
NPI assigned
Aug 13, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 18, 2024

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 1307 WI Primary

Addresses

Primary practice location

1111 Delafield St Ste 215
Waukesha, WI 53188-3403

Mailing address

1111 Delafield St Ste 215
Waukesha, WI 53188-3403
Phone (262) 542-0074

Other identifiers 1

IdentifierTypeStateIssuer
1703OtherWILICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, NM2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20200320002377 WI Practitioner - Physician Assistant 8820211402 Reassigns benefits to 3 organizations
I20250212001475 NM Practitioner - Physician Assistant 8820211402 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Los Alamos Physician Practices LLCGroup PAC ID 4587661541, 19 clinicians

Practice addresses (Care Compare)

1302 Calle de la Merced
Suite E
Espanola, NM 87532-2630
Phone (505) 753-9292

3917 W Rd
Suite 137
Los Alamos, NM 87544-5307
Phone (505) 661-9526

Hospital & facility affiliations

  • Los Alamos Medical Center Hospital, Los Alamos, NM, CCN 320033

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Ascension Medical Group-Southeast Wisconsin Inc Physician Assistant CurrentSince May 15, 2021 Accepting new patients
Los Alamos Physician Practices, LLC CurrentSince Jan 2, 2025 Accepting new patients
Prohealth Medical Group Inc Past Accepting new patients

Locations

3917 West Rd
Ste 137
Los Alamos, NM 87544
Phone (505) 661-8500

3917 West Rd
Ste 139
Los Alamos, NM 87544
Phone (505) 661-3030

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

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

Interoperability endpoints

  • Direct secure messaging: william.mustas.1@19849.direct.athenahealth.com
  • Direct secure messaging: williammustas@metro.medalliesdirect.net

Organizations & group practices 6

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": "1155427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726617600000",
    "number": "1629080932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 DELAFIELD ST STE 215",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531883403",
            "telephone_number": "262-542-0074",
            "fax_number": "262-542-2803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 DELAFIELD ST STE 215",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531883403",
            "telephone_number": "262-542-0074",
            "fax_number": "262-542-2803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUSTAS",
        "first_name": "WILLIAM",
        "middle_name": "P",
        "credential": "P.A.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-13",
        "last_updated": "2024-09-18",
        "certification_date": "2024-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "1307",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "1703",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waukesha, WI

Sources for this page

Verify at the official NPI Registry.