Elissa Kowaleski, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

3793 - 23 Issued in WI

Practice address

10610 N Port Washington Rd
Mequon, WI 53092-5013

Phone

(414) 771-6780

Fax

(414) 238-2424

NPI assigned

Aug 29, 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

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advanced Ear Nose and Throat Specialists, SCGroup PAC ID 9335106319, 33 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Advanced Ear Nose & Throat Specialists, SC

  • Plastic Surgery within the Head & Neck (Otolaryngology) Physician
  • Milwaukee, WI
  • NPI 1689782427
  Medicare reassignment Care Compare group
• Advanced Ear Nose & Throat Specialists, SC

  • Otolaryngology Physician
  • Miamisburg, OH
  • NPI 1811717887
  NPD
• Central Dupage Physician Group

  • Family Medicine Physician
  • Carol Stream, IL
  • NPI 1033149844
  NPD (past)

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

{
    "created_epoch": "1472428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641254400000",
    "number": "1841746989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10001 W INNOVATION DR STE 200",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532264851",
            "telephone_number": "888-938-3838",
            "fax_number": "888-919-1083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10610 N PORT WASHINGTON RD",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530925013",
            "telephone_number": "414-771-6780",
            "fax_number": "414-238-2424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOWALESKI",
        "first_name": "ELISSA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-29",
        "last_updated": "2022-01-04",
        "certification_date": "2022-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "3793 - 23",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tracy Lynn Koltun, RN
• Mark J Kortebein, DDS
• Madhumathi Kosaraju, MD
• Kathryn J Kostic, MD
• Kristen Kotecki
• Melissa Krabbe, M.S., BCBA
• Courtney Elizabeth Kraemer, APNP
• Kathleen Maria Kramer, PH.D.
• Carla B Kramoris, PT
• Erica Krause

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2022; 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.