Michael John Sermon, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

8231-23 Issued in WI

Practice address

606 River PL
Monona, WI 53716-4034

Phone

(608) 233-2378

Fax

(608) 233-2375

NPI assigned

Jul 16, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Mar 19, 2025 through Mar 19, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Functional Medicine of Idaho PC

  • Family Medicine Physician
  • Boise, ID
  • NPI 1336656040
  NPD (past)

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

{
    "created_epoch": "1342396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739318400000",
    "number": "1841545902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "606 RIVER PL",
            "city": "MONONA",
            "state": "WI",
            "postal_code": "537164034",
            "telephone_number": "608-233-2378",
            "fax_number": "208-233-2375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "606 RIVER PL",
            "city": "MONONA",
            "state": "WI",
            "postal_code": "537164034",
            "telephone_number": "608-233-2378",
            "fax_number": "608-233-2375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SERMON",
        "first_name": "MICHAEL",
        "middle_name": "JOHN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-16",
        "last_updated": "2025-02-12",
        "certification_date": "2025-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA1764",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "8231-23",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard D. Schwichtenberg, LCSW
• Scott L Fenton, PSYD, LLC
• Scott White Chiropractic LLC
• Elizabeth Seeliger
• Doris A Seitz, R.PH.
• Jeremiah J Shaw, MD
• Bronwyn Shiffer
• Shopko Institutional Care Services Co LLC
• Shopko Stores Operating Co LLC
• Shopko Stores Operating Co. LLC

• Physician Assistant in Monona, WI
• Providers in Monona, WI by specialty
• Physician Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.