Jack Avak Tertadian, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

34176-020 Issued in WI

Practice address

5900 S. Lake Drive
Cudahy, WI 53110

Phone

(414) 489-4190

Fax

(414) 489-4015

NPI assigned

Aug 22, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 2

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

Specialty

Internal Medicine

Education

Medical College of Wisconsin, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lakeshore Medical Clinic LLCGroup PAC ID 7719890730, 375 clinicians

Advantage Physical Therapy and Sports Rehab, LLCGroup PAC ID 8022016336, shared by 3 NPIs, 289 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Aurora at Home Home health agency, Milwaukee, WI, CCN 527001
• Aurora at Home Hospice, Wauwatosa, WI, CCN 521528
• Aurora St Lukes Medical Center Hospital, Milwaukee, WI, CCN 520138
• West Allis Memorial Hospital Hospital, West Allis, WI, CCN 520139

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jtertadian23906@direct.myadvocateaurora.org

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.

• Lakeshore Medical Clinic, LLC

  • Family Medicine Physician
  • St Francis, WI
  • NPI 1003861188
  Medicare reassignment Care Compare group NPD
• Aurora Medical Group, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Manitowoc, WI
  • NPI 1801941075
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Aurora Health Care Metro, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Cudahy, WI
  • NPI 1235355983

  Hospital

  Care Compare affiliation
• Aurora Health Care Metro, Inc.

  • General Acute Care Hospital
  • Milwaukee, WI
  • NPI 1861447179
  Care Compare affiliation
• Visiting Nurse Association of Wisconsin, Inc.

  dba Aurora at Home

  • Community Based Hospice Care Agency
  • Wauwatosa, WI
  • NPI 1023145331
  Care Compare affiliation
• Visiting Nurse Association of Wisconsin, Inc.

  dba Aurora at Home

  • Home Health Agency
  • West Allis, WI
  • NPI 1134255037
  Care Compare affiliation
• West Allis Memorial Hospital, Inc.

  dba Aurora West Allis Medical Center

  • Clinic/Center
  • West Allis, WI
  • NPI 1235345695

  Hospital

  Care Compare affiliation
• West Allis Memorial Hospital, Inc.

  dba Aurora West Allis Medical Center

  • General Acute Care Hospital
  • West Allis, WI
  • NPI 1407801640
  Care Compare affiliation

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

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722556800000",
    "number": "1689780462",
    "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": "5900 S. LAKE DRIVE",
            "city": "CUDAHY",
            "state": "WI",
            "postal_code": "53110",
            "telephone_number": "414-489-4190",
            "fax_number": "414-489-4015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TERTADIAN",
        "first_name": "JACK",
        "middle_name": "AVAK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-22",
        "last_updated": "2024-08-02",
        "certification_date": "2024-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "34176-020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31953000",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jtertadian23906@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "5900 S. Lake Drive",
            "city": "Cudahy",
            "state": "WI",
            "country_code": "US",
            "postal_code": "53110",
            "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": "5900 S. Lake Drive",
            "city": "Cudahy",
            "state": "WI",
            "country_code": "US",
            "postal_code": "53110",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lynette Stefanec, RN BSN
• Rom A Stevens, M.D.
• Florin Stuleanu, M.D.
• Leyda M Su Ham, D.O.
• Saroja Sunkara
• Kimberly R Thomas
• Sara Ann Thomas, DPT
• Lucie Toczyl
• Delores E Tomasik
• Norwi Aisha Touray

• Internal Medicine Physician in Cudahy, WI
• Providers in Cudahy, WI by specialty
• Internal Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.