Individual provider Active NPI

Michael Eugene Tjarksen, M.D.

  • Orthopaedic Surgery Physician
  • Pewaukee, WI
National Provider Identifier
1639152747
Registry record updated Dec 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
39946 Issued in WI
Practice address
N15W28300 Golf Rd
Pewaukee, WI 53072-4800
Phone
(262) 544-5311
Fax
(262) 544-6820
NPI assigned
Nov 22, 2005
Last updated
Dec 27, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 39946 WI Primary
Orthopaedic Surgery of the Spine Physician 207XS0117X 39946 WI

Addresses

Primary practice location

N15W28300 Golf Rd
Pewaukee, WI 53072-4800

Mailing address

N15W28300 Golf Rd
Pewaukee, WI 53072-4800
Phone (262) 303-5055

Other identifiers 1

IdentifierTypeStateIssuer
1639152747MedicaidWI

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081122000145 WI Practitioner - Orthopedic Surgery 1658260559 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
University of Michigan Medical School, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

N15W28300 Golf Rd
Pewaukee, WI 53072-4800
Phone (262) 303-5055

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion29
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10
Laminectomy or laminotomy (partial removal of spine bones)1-10
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
39946WIMDOrthopaedic Surgery of the Spine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Orthopaedic Associates of Wisconsin, SC Orthopaedic Surgery CurrentSince Sep 1, 1998 Accepting new patients
Orthopaedic Associates of Wisconsin SC Orthopaedic Surgery CurrentSince Sep 1, 1998 Accepting new patients
Prohealth Medical Group Inc Past Accepting new patients

Locations

W180N8085 Town Hall Rd
Menomonee Fls, WI 53051
Phone (262) 257-5000

1231 S Rochester St
Ste 100
Mukwonago, WI 53149

N15W28300 Golf Rd
Pewaukee, WI 53072

N14W23900 Stone Ridge Dr
Waukesha, WI 53188
Phone (262) 549-3030

Interoperability endpoints

  • Direct secure messaging: mtjarksen12035@direct.phci.org

Organizations & group practices 3

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 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": "1132617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577404800000",
    "number": "1639152747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N15W28300 GOLF RD",
            "city": "PEWAUKEE",
            "state": "WI",
            "postal_code": "530724800",
            "telephone_number": "262-303-5055",
            "fax_number": "262-303-5057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N15W28300 GOLF RD",
            "city": "PEWAUKEE",
            "state": "WI",
            "postal_code": "530724800",
            "telephone_number": "262-544-5311",
            "fax_number": "262-544-6820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TJARKSEN",
        "first_name": "MICHAEL",
        "middle_name": "EUGENE",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-22",
        "last_updated": "2019-12-27",
        "certification_date": "2019-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "WI",
            "license": "39946",
            "primary": true
        },
        {
            "code": "207XS0117X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": "WI",
            "license": "39946",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1639152747",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pewaukee, WI

Sources for this page

Verify at the official NPI Registry.