NPIMap

Individual provider Active NPI

Jeremy Michael Philipsen, DPM

  • Podiatrist
  • Pewaukee, WI
National Provider Identifier
1740773613
Registry record updated Jan 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
PENDING Issued in PA
Practice address
2835 N Grandview Blvd Ste 300
Pewaukee, WI 53072-5591
Phone
(262) 542-3779
Fax
(262) 542-4428
NPI assigned
Jun 14, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X PENDING PA Primary

Addresses

Primary practice location

2835 N Grandview Blvd Ste 300
Pewaukee, WI 53072-5591

Mailing address

2835 N Grandview Blvd Ste 300
Pewaukee, WI 53072-5591
Phone (262) 542-3779

Other practice location 1

1400 Locust St Building B
Room 9520
Pittsburgh, PA 15219
Phone (412) 232-5515

Other identifiers 1

IdentifierTypeStateIssuer
100177596MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210804002798 WI Practitioner - Podiatry 7810391455 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Foot and Ankle Associates of Wi LTDGroup PAC ID 3779500442, 7 clinicians
Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians

Practice addresses (Care Compare)

2835 N Grandview Blvd
Suite 300
Pewaukee, WI 53072-5591
Phone 26254237794

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

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue97
Removal of skin lesions13
Removal of nail tissue441
Removal or shaving of skin growth49
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PENDINGPAMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Medical Group, Inc. CurrentSince Dec 1, 2021 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Dec 1, 2021 Accepting new patients
Foot and Ankle Associates of Wi LTD Podiatrist CurrentSince Aug 1, 2021 Accepting new patients

Locations

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

2835 N Grandview Blvd
Ste 300
Pewaukee, WI 53072
Phone (262) 542-3779

2835 N Grandview Blvd
Pewaukee, WI 53072
Phone (262) 395-4015

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

Interoperability endpoints

  • Direct secure messaging: jphilipsen152855@direct.phci.org

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.

Hospital & facility affiliations 5

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": "1528934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737331200000",
    "number": "1740773613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2835 N GRANDVIEW BLVD STE 300",
            "city": "PEWAUKEE",
            "state": "WI",
            "postal_code": "530725591",
            "telephone_number": "262-542-3779",
            "fax_number": "262-542-4428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2835 N GRANDVIEW BLVD STE 300",
            "city": "PEWAUKEE",
            "state": "WI",
            "postal_code": "530725591",
            "telephone_number": "262-542-3779",
            "fax_number": "262-542-4428"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1400 Locust St Building B",
            "address_2": "Room 9520",
            "address_purpose": "LOCATION",
            "city": "Pittsburgh",
            "state": "PA",
            "postal_code": "15219",
            "country_code": "US",
            "telephone_number": "412-232-5515",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHILIPSEN",
        "first_name": "JEREMY",
        "middle_name": "MICHAEL",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-14",
        "last_updated": "2025-01-20",
        "certification_date": "2025-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "PA",
            "license": "PENDING",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100177596",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pewaukee, WI

Sources for this page

Verify at the official NPI Registry.