Individual provider Active NPI

Donald J Hennessy, M.D.

  • Internal Medicine Physician
  • Cedarburg, WI
National Provider Identifier
1811960495
Registry record updated Jan 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
23781 Issued in WI
Practice address
N143W6515 Pioneer Rd
Cedarburg, WI 53012-2705
Phone
(262) 377-6933
Fax
(262) 376-2495
NPI assigned
Feb 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 23781 WI Primary

Addresses

Primary practice location

N143W6515 Pioneer Rd
Cedarburg, WI 53012-2705

Mailing address

N143W6515 Pioneer Rd
Cedarburg, WI 53012-2705
Phone (262) 377-6933

Other practice location 1

W180N7950 Town Hall Rd
Menomonee Falls, WI 53051-4049
Phone (262) 255-2500

Other identifiers 1

IdentifierTypeStateIssuer
30630400MedicaidWI

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
I20070305000735 WI Practitioner - Internal MedicinePractitioner - Hospitalist 6002919438 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Signify Health Medical Associates, PLLC CurrentSince Aug 14, 2023 Accepting new patients
Prohealth Medical Group Inc. Internal Medicine PastSince Jul 1, 1987 Accepting new patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. Internal Medicine Past Accepting new patients

Locations

4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037

811 E Washington Ave
Madison, WI 53703
Phone (469) 466-7420

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.

NPI Registry JSON

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

{
    "created_epoch": "1139788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516060800000",
    "number": "1811960495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N143W6515 PIONEER RD",
            "city": "CEDARBURG",
            "state": "WI",
            "postal_code": "530122705",
            "telephone_number": "262-377-6933",
            "fax_number": "262-376-2495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N143W6515 PIONEER RD",
            "city": "CEDARBURG",
            "state": "WI",
            "postal_code": "530122705",
            "telephone_number": "262-377-6933",
            "fax_number": "262-376-2495"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "W180N7950 Town Hall Rd",
            "address_purpose": "LOCATION",
            "city": "Menomonee Falls",
            "state": "WI",
            "postal_code": "530514049",
            "country_code": "US",
            "telephone_number": "262-255-2500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HENNESSY",
        "first_name": "DONALD",
        "middle_name": "J",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-13",
        "last_updated": "2018-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "23781",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30630400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cedarburg, WI

Sources for this page

Verify at the official NPI Registry.