Active NPI
Ronald J Zacker, PA
- Physician Assistant
- Milwaukee, WI
National Provider Identifier
1841382827
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 1915-023
- Practice address
- 2900 W Oklahoma Ave
Milwaukee, WI 53215-4330 - Phone
- (414) 649-6588
- Fax
- (770) 237-1723
- NPI assigned
- Sep 28, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1915-023 | WI | Primary |
Addresses
Primary practice location
2900 W Oklahoma Ave
Milwaukee, WI 53215-4330
Mailing address
2900 W Oklahoma Ave
Milwaukee, WI 53215-4330
Phone (414) 649-6588
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001 | Other | WI | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20051216000682 | WI | Practitioner - Physician Assistant | 7416978424 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1915-023 | WI | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lac Courte Oreilles Governing | Current | Accepting new patients |
Locations
13380 W Trepania Rd
Hayward, WI 54843
Phone (715) 638-5100
Organizations & group practices 1
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.
-
- Clinic/Center
- Hayward, WI
- NPI 1194830208
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1216339200000",
"number": "1841382827",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2900 W OKLAHOMA AVE",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532154330",
"telephone_number": "414-649-6588",
"fax_number": "770-237-1723"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2900 W OKLAHOMA AVE",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532154330",
"telephone_number": "414-649-6588",
"fax_number": "770-237-1723"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZACKER",
"first_name": "RONALD",
"middle_name": "J",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-28",
"last_updated": "2008-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WI",
"license": "1915-023",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "001",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2008; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.