Individual provider Active NPI

Wanda M Marquart, PAC

  • Physician Assistant
  • Summit, WI
National Provider Identifier
1669420816
Registry record updated Apr 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1420-023 Issued in WI
Practice address
36500 Aurora Dr
Summit, WI 53066-4899
Phone
(262) 434-1000
NPI assigned
May 4, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 1, 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 1420-023 WI Primary

Addresses

Primary practice location

36500 Aurora Dr
Summit, WI 53066-4899

Mailing address

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

Other practice location 1

2900 W Oklahoma Ave
Milwaukee, WI 53215-4330
Phone (414) 649-7299

Other identifiers 1

IdentifierTypeStateIssuer
42984600MedicaidWI

Other names 1

  • Wanda M Sheild Former name

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address wsheild40993@direct.aurora.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
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
I20040206000863 WI Practitioner - Physician Assistant 8022901503 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1420-023WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Medical Group, Inc. CurrentSince Nov 26, 2007 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Nov 26, 2007 Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients

Locations

5900 S Lake Dr
Cudahy, WI 53110
Phone (414) 489-4055

7080 N Port Washington Rd
Glendale, WI 53217
Phone (414) 228-4940

1575 N Rivercenter Dr
Milwaukee, WI 53212
Phone (414) 283-8444

2900 W Oklahoma Ave
Milwaukee, WI 53215
Phone (414) 385-2590

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

36500 Aurora Dr
Summit, WI 53066
Phone (262) 434-1000

915 Summit Ave
Summit, WI 53066
Phone (262) 569-2300

620 15th Ave
Union Grove, WI 53182
Phone (262) 878-1211

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711929600000",
    "number": "1669420816",
    "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": "36500 AURORA DR",
            "city": "SUMMIT",
            "state": "WI",
            "postal_code": "530664899",
            "telephone_number": "262-434-1000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2900 W Oklahoma Ave",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532154330",
            "country_code": "US",
            "telephone_number": "414-649-7299",
            "fax_number": "414-649-6694",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARQUART",
        "first_name": "WANDA",
        "middle_name": "M",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-04",
        "last_updated": "2024-04-01",
        "certification_date": "2024-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "1420-023",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42984600",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "wsheild40993@direct.aurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2900 W Oklahoma Ave",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532154330",
            "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": "2900 W Oklahoma Ave",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532154330",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "WANDA",
            "last_name": "SHEILD",
            "middle_name": "M",
            "credential": "PAC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Summit, WI

Sources for this page

Verify at the official NPI Registry.