Individual provider Active NPI

Jillian Huyck Hudson, MD

  • Family Medicine Physician
  • South Milwaukee, WI
National Provider Identifier
1730488404
Registry record updated Dec 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
60403-20 Issued in WI
Practice address
3611 S Chicago Ave
Suite 100
South Milwaukee, WI 53172-3738
Phone
(414) 762-7270
Fax
(414) 762-7864
NPI assigned
Mar 21, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 4, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 60403-20 WI Primary

Addresses

Primary practice location

3611 S Chicago Ave
Suite 100
South Milwaukee, WI 53172-3738

Mailing address

PO Box 735044
Chicago, IL 60673-5044

Other identifiers 1

IdentifierTypeStateIssuer
100034397MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address jhudson22999@direct.myadvocateaurora.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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140909001931 WI Practitioner - Family Practice 7315170727 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lakeshore Medical Clinic LLCGroup PAC ID 7719890730, 375 clinicians

Practice addresses (Care Compare)

200 E Ryan Rd
Oak Creek, WI 53154-4563
Phone (414) 570-3590

2000 E Layton Ave
Saint Francis, WI 53235-6053
Phone (414) 744-6589

3305 S 20TH St
Milwaukee, WI 53215-4940

3611 S Chicago Ave
S Milwaukee, WI 53172-3738
Phone (414) 762-7270

Hospital & facility affiliations

  • Aurora at Home Home health agency, Milwaukee, WI, CCN 527001
  • Aurora St Lukes Medical Center Hospital, Milwaukee, WI, CCN 520138

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
60403-20WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeshore Medical Clinic LTD Family Medicine CurrentSince Aug 1, 2014 Accepting new patients
Lakeshore Medical Clinic, LLC Family Medicine CurrentSince Aug 1, 2014 Accepting new patients

Locations

S74W16775 Janesville Rd
Muskego, WI 53150
Phone (414) 422-4747

3611 S Chicago Ave
South Milwaukee, WI 53172
Phone (414) 762-2450

3611 S Chicago Ave
Ste 100
South Milwaukee, WI 53172
Phone (414) 762-7270

2000 E Layton Ave
St Francis, WI 53235
Phone (414) 744-7880

Interoperability endpoints

  • Direct secure messaging: jhudson22999@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 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": "1300665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701648000000",
    "number": "1730488404",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3611 S CHICAGO AVE",
            "address_2": "SUITE 100",
            "city": "SOUTH MILWAUKEE",
            "state": "WI",
            "postal_code": "531723738",
            "telephone_number": "414-762-7270",
            "fax_number": "414-762-7864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUDSON",
        "first_name": "JILLIAN",
        "middle_name": "HUYCK",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-03-21",
        "last_updated": "2023-12-04",
        "certification_date": "2023-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "60403-20",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100034397",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jhudson22999@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "3611 S Chicago Ave",
            "address_2": "Suite 100",
            "city": "South Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531723738",
            "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": "3611 S Chicago Ave",
            "address_2": "Suite 100",
            "city": "South Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531723738",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in South Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.