Individual provider Active NPI

Nicholas Kriesel, PA-C, ATC

  • Physician Assistant
  • Pewaukee, WI
National Provider Identifier
1649792235
Registry record updated Aug 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
N15W28300 Golf Rd
Pewaukee, WI 53072-4800
Phone
(262) 303-5055
NPI assigned
Jul 14, 2017
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 17, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic Trainer 2255A2300X AL4910 FL
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

N15W28300 Golf Rd
Pewaukee, WI 53072-4800

Mailing address

10610 W Rogers St
West Allis, WI 53227-1247
Phone (414) 530-0928

Other practice location 1

3450 Hull Rd
Gainesville, FL 32607-4144
Phone (352) 273-7001

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220831003077 WI Practitioner - Physician Assistant 9638553274 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1231 S Rochester St
Suite 100
Mukwonago, WI 53149-9040
Phone (262) 303-5055

285 S Moorland Rd
Brookfield, WI 53005-4207
Phone (262) 303-5055

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

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
AL4910FLMDAthletic Trainer

Practice roles

OrganizationSpecialtyStatusNew patients
Orthopaedic Associates of Wisconsin SC CurrentSince Aug 4, 2022 Accepting new patients

Locations

285 S Moorland Rd
Brookfield, WI 53005
Phone (810) 331-0939

1231 S Rochester St
Ste 100
Mukwonago, WI 53149

N15W28300 Golf Rd
Pewaukee, WI 53072

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 and National Provider Directory roles.

Hospital & facility affiliations 3

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": "1499990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660694400000",
    "number": "1649792235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10610 W ROGERS ST",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532271247",
            "telephone_number": "414-530-0928"
        },
        {
            "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": "262-303-5055"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3450 Hull Rd",
            "address_purpose": "LOCATION",
            "city": "Gainesville",
            "state": "FL",
            "postal_code": "326074144",
            "country_code": "US",
            "telephone_number": "352-273-7001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KRIESEL",
        "first_name": "NICHOLAS",
        "credential": "PA-C, ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-07-14",
        "last_updated": "2022-08-17",
        "certification_date": "2022-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "FL",
            "license": "AL4910",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pewaukee, WI

Sources for this page

Verify at the official NPI Registry.