Individual provider Active NPI

Justinn Tanem

  • Pediatric Anesthesiology Physician
  • Milwaukee, WI
National Provider Identifier
1780950964
Registry record updated Apr 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Anesthesiology PhysicianTaxonomy code 207LP3000X
License
61773 Issued in WI
Practice address
9000 W Wisconsin Ave
Milwaukee, WI 53226-4874
Phone
(414) 266-3560
Fax
(414) 266-6092
NPI assigned
Apr 1, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Anesthesiology Physician 207LP3000X 61773 WI Primary

Addresses

Primary practice location

9000 W Wisconsin Ave
Milwaukee, WI 53226-4874

Mailing address

9000 W Wisconsin Ave
Milwaukee, WI 53226-4874
Phone (414) 266-3560

Other practice location 1

8345 Gridley Ave
Wauwatosa, WI 53213-3041
Phone (608) 698-3100

Other practice location 2

9200 W Wisconsin Ave
Milwaukee, WI 53226-3522
Phone (414) 805-8700

Other identifiers 1

IdentifierTypeStateIssuer
1780950964MedicaidWI

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
I20190530000038 WI Practitioner - AnesthesiologyPractitioner - Pediatric Medicine 3779802228 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
AnesthesiologyAlso: Pediatric Medicine
Education
Medical College of Wisconsin, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Childrens Specialty Group IncGroup PAC ID 2567813447, 206 clinicians

Practice addresses (Care Compare)

9000 W Wisconsin Ave
Milwaukee, WI 53226-4874
Phone (414) 266-2000

Merit-based Incentive Payment System (MIPS)

Final score
87.99 of 100Reported as group
Quality
82.81
Promoting interoperability
100
Improvement activities
40
Cost
77.15

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
61773WIMDPediatric Anesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Medical College of Wisconsin, Inc. CurrentSince Jun 1, 2019 Accepting new patients
Children'S Specialty Group, Inc. CurrentSince Sep 16, 2024 Accepting new patients

Locations

9200 W Wisconsin Ave
Wauwatosa, WI 53226
Phone (414) 259-3000

9000 W Wisconsin Ave
Wauwatosa, WI 53226
Phone (414) 266-2625

8701 Watertown Plank Rd
Wauwatosa, WI 53226
Phone (414) 456-4100

Interoperability endpoints

  • Direct secure messaging: jtanem6718@direct.chw.org
  • Direct secure messaging: jtanemmd84001@direct.froedtert.com

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1333238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713830400000",
    "number": "1780950964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9000 W WISCONSIN AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532264874",
            "telephone_number": "414-266-3560",
            "fax_number": "414-266-6092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9000 W WISCONSIN AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532264874",
            "telephone_number": "414-266-3560",
            "fax_number": "414-266-6092"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8345 Gridley Ave",
            "address_purpose": "LOCATION",
            "city": "Wauwatosa",
            "state": "WI",
            "postal_code": "532133041",
            "country_code": "US",
            "telephone_number": "608-698-3100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9200 W Wisconsin Ave",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532263522",
            "country_code": "US",
            "telephone_number": "414-805-8700",
            "fax_number": "414-259-1522",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TANEM",
        "first_name": "JUSTINN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-01",
        "last_updated": "2024-04-23",
        "certification_date": "2024-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207LP3000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pediatric Anesthesiology",
            "state": "WI",
            "license": "61773",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1780950964",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.