Individual provider Active NPI

Matthew David Wonchala, MD

  • Diagnostic Radiology Physician
  • Waukesha, WI
National Provider Identifier
1740773563
Registry record updated Sep 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
101844 Issued in WI
Practice address
W231N1440 Corporate CT
Waukesha, WI 53186-1303
Phone
(262) 896-6000
NPI assigned
Jun 7, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 10, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X 4351031905 MI
Diagnostic Radiology Physician 2085R0202X 4301502914 MI
Diagnostic Radiology Physician 2085R0202X 101844 WI Primary

Addresses

Primary practice location

W231N1440 Corporate CT
Waukesha, WI 53186-1303

Mailing address

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

Other practice location 1

18101 Oakwood Blvd
Dearborn, MI 48124-4089
Phone (313) 593-7000

Other practice location 2

2799 W Grand Blvd
Detroit, MI 48202-2608
Phone (313) 916-7425

Other identifiers 1

IdentifierTypeStateIssuer
100281813MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/
Direct Messaging Address mwonchala403913@direct.myadvocateaurora.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, WI2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20230510001589 MI Practitioner - Diagnostic Radiology 6204182066 Reassigns benefits to 1 organization
I20240816000632 WI Practitioner - Diagnostic Radiology 6204182066 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Central Michigan College of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lakeshore Medical Clinic LLCGroup PAC ID 7719890730, 375 clinicians
Aurora Advanced Healthcare, Inc.Group PAC ID 3375625833, 1,107 clinicians
Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians

Practice addresses (Care Compare)

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

3003 W Good Hope Rd
Milwaukee, WI 53209-2042
Phone (414) 352-3100

W231 N1440 Corporate Court
Waukesha, WI 53186-1303
Phone (262) 896-6070

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4351031905MIMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeshore Medical Clinic, LLC Single Specialty CurrentSince Jul 12, 2024 Accepting new patients
Aurora Medical Group, Inc. Single Specialty CurrentSince Jul 12, 2024 Accepting new patients
Henry Ford Health System Single Specialty CurrentSince May 4, 2023 Accepting new patients
Aurora Advanced Healthcare Inc Single Specialty CurrentSince Jul 12, 2024 Accepting new patients
Aurora Health Care Metro, Inc. Single Specialty CurrentSince Jul 12, 2024 Accepting new patients
Henry Ford Health System Single Specialty Current Accepting new patients
Henry Ford Health System CurrentSince May 4, 2023 Accepting new patients
Aurora Medical Group, Inc. Single Specialty CurrentSince Jul 12, 2024 Accepting new patients
Aurora Advanced Healthcare, Inc. Single Specialty CurrentSince Jul 12, 2024 Accepting new patients

Locations

2799 W Grand Blvd
Detroit, MI 48202
Phone (313) 876-2062

1 Ford Pl
Ste 3A
Detroit, MI 48202
Phone (313) 874-2892

6777 W Maple Rd
West Bloomfield, MI 48322
Phone (248) 325-1000

3003 W Good Hope Rd
Glendale, WI 53209
Phone (414) 352-3100

12203 N Corporate Pkwy
Mequon, WI 53092
Phone (262) 387-8200

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

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

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

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

W231N1440 Corporate Ct
Waukesha, WI 53186
Phone (262) 896-6000

Interoperability endpoints

  • Direct secure messaging: mwonchala403913@direct.myadvocateaurora.org

Organizations & group practices 9

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 7

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": "1528329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725926400000",
    "number": "1740773563",
    "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": "W231N1440 CORPORATE CT",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531861303",
            "telephone_number": "262-896-6000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "18101 Oakwood Blvd",
            "address_purpose": "LOCATION",
            "city": "Dearborn",
            "state": "MI",
            "postal_code": "481244089",
            "country_code": "US",
            "telephone_number": "313-593-7000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2799 W Grand Blvd",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482022608",
            "country_code": "US",
            "telephone_number": "313-916-7425",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WONCHALA",
        "first_name": "MATTHEW",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-06-07",
        "last_updated": "2024-09-10",
        "certification_date": "2024-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MI",
            "license": "4351031905",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MI",
            "license": "4301502914",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WI",
            "license": "101844",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100281813",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "W231N1440 Corporate Ct",
            "city": "Waukesha",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531861303",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mwonchala403913@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "W231N1440 Corporate Ct",
            "city": "Waukesha",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531861303",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Waukesha, WI

Sources for this page

Verify at the official NPI Registry.