NPIMap

Individual provider Active NPI

Deanna L Roecker, PA-C

  • Physician Assistant
  • Milwaukee, WI
National Provider Identifier
1851336408
Registry record updated May 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
610-023 Issued in WI
Practice address
111 E Wisconsin Ave
Suite 2000
Milwaukee, WI 53202-4815
Phone
(414) 290-6720
Fax
(414) 290-6755
NPI assigned
Jun 18, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 19, 2008

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085-002184 IL
Physician Assistant 363A00000X 610-023 WI Primary

Addresses

Primary practice location

111 E Wisconsin Ave
Suite 2000
Milwaukee, WI 53202-4815

Mailing address

111 E Wisconsin Ave
Suite 2000
Milwaukee, WI 53202-4815
Phone (414) 290-6720

Other identifiers 3

IdentifierTypeStateIssuer
42963200MedicaidWI
970008498OtherWIMEDICARE RAILROAD
970008514OtherWIMEDICARE RAILROAD

Other names 1

  • Deanna L Willing Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
085-002184ILMDPhysician Assistant
610-023WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc-Swedishamerican Emergency Physicians, LLC Physician Assistant PastSince Dec 15, 2019 Accepting new patients
Ihc-Swedishamerican Emergency Physicians, LLC Physician Assistant PastSince Dec 15, 2019 Accepting new patients
United Occupational Medicine and Walk in Services, LLC Physician Assistant Past Accepting new patients
Health Dynamics, LLC Physician Assistant Past Accepting new patients

Organizations & group practices 4

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": "1150588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211155200000",
    "number": "1851336408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 E WISCONSIN AVE",
            "address_2": "SUITE 2000",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532024815",
            "telephone_number": "414-290-6720",
            "fax_number": "414-290-6755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 E WISCONSIN AVE",
            "address_2": "SUITE 2000",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532024815",
            "telephone_number": "414-290-6720",
            "fax_number": "414-290-6755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROECKER",
        "first_name": "DEANNA",
        "middle_name": "L",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-18",
        "last_updated": "2008-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085-002184",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "610-023",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42963200",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "970008498",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "970008514",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DEANNA",
            "last_name": "WILLING",
            "middle_name": "L",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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 May 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.