Individual provider Active NPI

Antonio Ippolito Montemurro, DPM

  • Primary Podiatric Medicine Podiatrist
  • Pleasant Prairie, WI
National Provider Identifier
1700126562
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Podiatric Medicine PodiatristTaxonomy code 213EP1101X
License
1031-25 Issued in WI
Practice address
9697 Saint Catherines Dr Ste 300
Pleasant Prairie, WI 53158-2118
Phone
(262) 656-3338
Fax
(262) 656-3368
NPI assigned
Feb 15, 2013
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Podiatric Medicine Podiatrist 213EP1101X 016005538 IL
Primary Podiatric Medicine Podiatrist 213EP1101X 1031-25 WI Primary

Addresses

Primary practice location

9697 Saint Catherines Dr Ste 300
Pleasant Prairie, WI 53158-2118

Mailing address

6308 8TH Ave
Kenosha, WI 53143-5031
Phone (262) 656-3313

Other identifiers 2

IdentifierTypeStateIssuer
1700126562MedicaidWI
K400163324OtherWIMEDICARE

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140918000338 WI Practitioner - Podiatry 5193944437 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advantage Physical Therapy and Sports Rehab, LLCGroup PAC ID 8022016336, shared by 3 NPIs, 289 clinicians
Froedtert South IncGroup PAC ID 9537071196, 158 clinicians

Practice addresses (Care Compare)

10222 74TH St
Suite 211
Kenosha, WI 53142-6810
Phone (262) 925-5020

6308 8TH Ave
Kenosha, WI 53143-5031
Phone (262) 653-5300

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.15 of 100Reported as group
Quality
69.39
Promoting interoperability
100
Improvement activities
40
Cost
74.44

Procedures performed for Medicare patients

ProcedureNumber of procedures
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10
Removal of tissue12
Removal of skin lesions1-10
Removal of nail tissue90

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
016005538ILMDPrimary Podiatric Medicine Podiatrist
1031-25WIMDPrimary Podiatric Medicine Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Froedtert South, Inc. CurrentSince Jul 1, 2014 Accepting new patients
Froedtert South, Inc. Past Accepting new patients
Kenosha Pathology Consultants Past Accepting new patients

Locations

6308 8th Ave
Kenosha, WI 53143
Phone (262) 653-5300

9697 Saint Catherines Dr
#300
Pleasant Prairie, WI 53158

9697 Saint Catherines Dr
Ste 300
Pleasant Prairie, WI 53158
Phone (262) 577-8320

Interoperability endpoints

  • Direct secure messaging: amontemurro341955@direct.froedtert.com

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": "1360886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1700126562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6308 8TH AVE",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531435031",
            "telephone_number": "262-656-3313",
            "fax_number": "262-653-5850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9697 SAINT CATHERINES DR STE 300",
            "city": "PLEASANT PRAIRIE",
            "state": "WI",
            "postal_code": "531582118",
            "telephone_number": "262-656-3338",
            "fax_number": "262-656-3368"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTEMURRO",
        "first_name": "ANTONIO",
        "middle_name": "IPPOLITO",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-02-15",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213EP1101X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": "IL",
            "license": "016005538",
            "primary": false
        },
        {
            "code": "213EP1101X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": "WI",
            "license": "1031-25",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1700126562",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "K400163324",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pleasant Prairie, WI

Sources for this page

Verify at the official NPI Registry.