Individual provider Active NPI

Kirk I O'Hanison, NP

  • Nurse Practitioner
  • Milwaukee, WI
National Provider Identifier
1649877663
Registry record updated Oct 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
10431 Issued in WI
Practice address
11333 W National Ave
Milwaukee, WI 53227-3111
Phone
(414) 329-4979
NPI assigned
Oct 2, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 10431-33 WI
Nurse Practitioner 363L00000X 10431 WI Primary

Addresses

Primary practice location

11333 W National Ave
Milwaukee, WI 53227-3111

Mailing address

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

Other practice location 1

17043 W Greenfield Ave
New Berlin, WI 53151-1364
Phone (262) 505-6260

Other identifiers 1

IdentifierTypeStateIssuer
100182435MedicaidWI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kohanison56857@direct.myadvocateaurora.org

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
I20211013001939 WI Practitioner - Nurse Practitioner 7517365059 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians

Practice addresses (Care Compare)

3509 Dewey St
Manitowoc, WI 54220-5813
Phone (920) 686-5731

Hospital & facility affiliations

  • Aurora at Home Home health agency, Milwaukee, WI, CCN 527001

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
10431-33WIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Medical Group, Inc. CurrentSince Sep 16, 2022 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Sep 16, 2022 Accepting new patients

Locations

3509 Dewey St
Manitowoc, WI 54220
Phone (920) 686-5731

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

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

11333 W National Ave
West Allis, WI 53227
Phone (414) 327-2295

Interoperability endpoints

  • Direct secure messaging: kohanison56857@direct.myadvocateaurora.org

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 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": "1601596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729468800000",
    "number": "1649877663",
    "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": "11333 W NATIONAL AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532273111",
            "telephone_number": "414-329-4979"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17043 W Greenfield Ave",
            "address_purpose": "LOCATION",
            "city": "New Berlin",
            "state": "WI",
            "postal_code": "531511364",
            "country_code": "US",
            "telephone_number": "262-505-6260",
            "fax_number": "262-505-6261",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "O'HANISON",
        "first_name": "KIRK",
        "middle_name": "I",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-10-02",
        "last_updated": "2024-10-21",
        "certification_date": "2024-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "10431-33",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "10431",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100182435",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kohanison56857@direct.myadvocateaurora.org",
            "affiliation": "N",
            "address_1": "6030 W Oklahoma Ave",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532194133",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.