Alicia Marie Chacon, OD

Primary specialty

Pediatric OptometristTaxonomy code 152WP0200X

License

3483-35 Issued in WI

Practice address

925 N 87TH St
Milwaukee, WI 53226-4812

NPI assigned

Jul 1, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Ms. Alicia Marie Ketcham Former name

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

Specialty

OptometryAlso: Pediatric Medicine

Education

Other, 2016

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)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: achacon57666@direct.chw.org

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.

• Children'S Specialty Group, Inc.

  • Pediatrics Physician
  • Milwaukee, WI
  • NPI 1942970405
  Medicare reassignment Care Compare group NPD
• The Medical College of Wisconsin, Inc.

  • Internal Medicine Physician
  • Milwaukee, WI
  • NPI 1699720086
  Medicare reassignment NPD

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

{
    "created_epoch": "1467331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710115200000",
    "number": "1831541887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "925 N 87TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532264812",
            "telephone_number": "414-266-2020",
            "fax_number": "414-266-2027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "925 N 87TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532264812"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8920 West Connell Ct.",
            "address_2": "130",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "53226",
            "country_code": "US",
            "telephone_number": "414-266-2021",
            "fax_number": "414-266-2027",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9000 W Wisconsin Ave",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532264874",
            "country_code": "US",
            "telephone_number": "414-805-3666",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1655 W Mequon Rd",
            "address_purpose": "LOCATION",
            "city": "Mequon",
            "state": "WI",
            "postal_code": "530923254",
            "country_code": "US",
            "telephone_number": "414-266-2020",
            "fax_number": "262-518-2624",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHACON",
        "first_name": "ALICIA",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-01",
        "last_updated": "2024-03-11",
        "certification_date": "2024-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "WI",
            "license": "3483-35",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1831541887",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1831541887",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALICIA",
            "last_name": "KETCHAM",
            "middle_name": "MARIE",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Louis-Marcel A Cesar, M.D.
• Jolie Cetnarowski
• CH Mason Health Clinic
• Kristina K. Cha-Vang, PHARMD
• Timothy Cha
• Ashish Chaddha, MD
• Daniel Steven Chadwick, PA-C
• Elizabeth Ann Chadwick
• Garrick Chaffin
• Bahareh Chagani, D.M.D.

• Pediatric Optometrist in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Pediatric Optometrist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.