Individual provider Active NPI

Mohammad Eyman Mortada, M.D.

  • Clinical Cardiac Electrophysiology Physician
  • Milwaukee, WI
National Provider Identifier
1770788036
Registry record updated Jun 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Cardiac Electrophysiology PhysicianTaxonomy code 207RC0001X
License
43167-020 Issued in WI
Practice address
2801 W Kinnickinnic River Pkwy
Suite 777
Milwaukee, WI 53215-3669
Phone
(414) 649-3390
Fax
(414) 649-5769
NPI assigned
Jun 18, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 43167-020 WI
Cardiovascular Disease Physician 207RC0000X 43167-020 WI
Clinical Cardiac Electrophysiology Physician 207RC0001X 43167-020 WI Primary

Addresses

Primary practice location

2801 W Kinnickinnic River Pkwy
Suite 777
Milwaukee, WI 53215-3669

Mailing address

PO Box 2040
Milwaukee, WI 53201-2040
Phone (414) 649-3390

Other identifiers 1

IdentifierTypeStateIssuer
34173300MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address mmortada20638@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
I20070807000635 WI Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Cardiac Electrophysiology 2062503972 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians

Practice addresses (Care Compare)

1020 N 12TH St
Milwaukee, WI 53233-1308
Phone (414) 219-3056

1500 Arbor Way
Kaukauna, WI 54130-7305
Phone (920) 766-3200

210 Wisconsin American Dr
Fond Du Lac, WI 54937-2999
Phone (920) 907-4800

2801 W Kinnickinnic River Pkwy
Milwaukee, WI 53215-3669
Phone (414) 385-8600

2900 W Oklahoma Ave
Milwaukee, WI 53215-4330
Phone (414) 646-5410

36500 Aurora Dr
Summit, WI 53066-4899
Phone (262) 434-5000

6901 W Edgerton Ave
Milwaukee, WI 53220-4420
Phone (414) 421-8400

855 N Westhaven Dr
Oshkosh, WI 54904-7668
Phone (920) 303-8700

8901 W Lincoln Ave
West Allis, WI 53227-2409
Phone (414) 329-5930

945 N 12TH St
Milwaukee, WI 53233-1305
Phone (414) 219-7300

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Pacemaker insertion or repair34

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
43167-020WIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Advanced Healthcare Inc CurrentSince May 1, 2020 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Sep 1, 2007 Accepting new patients
Aurora Advanced Healthcare, Inc. Internal Medicine CurrentSince May 1, 2020 Accepting new patients
Baycare Aurora, LLC Cardiovascular Disease CurrentSince Nov 4, 2021 Accepting new patients
West Allis Memorial Hospital, Inc. CurrentSince Nov 26, 2008 Accepting new patients
A2Cl Services, LLC Current Accepting new patients
Aurora Medical Group, Inc. Internal Medicine CurrentSince Sep 1, 2007 Accepting new patients
West Allis Memorial Hospital, Inc. CurrentSince Nov 26, 2008 Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients

Locations (25 of 28)

1905 E Huebbe Pkwy
Beloit, WI 53511
Phone (608) 364-2293

W3985 Highway NN
Elkhorn, WI 53121
Phone (262) 741-2000

12500 W Bluemound Rd
Elm Grove, WI 53122
Phone (262) 780-3434

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

2845 Greenbrier Rd
#1
Green Bay, WI 54311
Phone (920) 288-8100

2845 Greenbrier Rd
Green Bay, WI 54311
Phone (920) 288-3388

123 N Military Ave
Green Bay, WI 54303
Phone (920) 494-3421

2733 S Ridge Rd
Green Bay, WI 54304
Phone (920) 497-6200

2253 W Mason St
Green Bay, WI 54303
Phone (920) 327-7000

1004 E Sumner St
Hartford, WI 53027
Phone (262) 670-7000

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

10117 74th St
Ste 110
Kenosha, WI 53142
Phone (262) 697-1919

1900 South Ave
La Crosse, WI 54601
Phone (608) 775-2287

601 Reed Ave
Manitowoc, WI 54220
Phone (920) 682-8841

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

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

5017 S 110th St
Milwaukee, WI 53228
Phone (414) 427-8282

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

960 N 12th St
Milwaukee, WI 53233
Phone (414) 219-6093

1218 W Kilbourn Ave
Milwaukee, WI 53233
Phone (414) 219-7343

1575 N Rivercenter Dr
Milwaukee, WI 53212
Phone (414) 283-8444

2801 W Kinnickinnic River Pkwy
Ste 777
Milwaukee, WI 53215
Phone (414) 649-3390

8400 Washington Ave
Mount Pleasant, WI 53406
Phone (262) 231-3000

620 Warren St
Redgranite, WI 54970
Phone (920) 566-0620

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

Interoperability endpoints

  • Direct secure messaging: mmortada20638@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": "1182124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655942400000",
    "number": "1770788036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2040",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532012040",
            "telephone_number": "414-649-3390",
            "fax_number": "414-649-5769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 W KINNICKINNIC RIVER PKWY",
            "address_2": "SUITE 777",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532153669",
            "telephone_number": "414-649-3390",
            "fax_number": "414-649-5769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORTADA",
        "first_name": "MOHAMMAD",
        "middle_name": "EYMAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-18",
        "last_updated": "2022-06-23",
        "certification_date": "2022-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "43167-020",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "WI",
            "license": "43167-020",
            "primary": false
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "WI",
            "license": "43167-020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34173300",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mmortada20638@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2801 W Kinnickinnic River Pkwy",
            "address_2": "Suite 777",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532153669",
            "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": "2801 W Kinnickinnic River Pkwy",
            "address_2": "Suite 777",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532153669",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.