Individual provider Active NPI

Antoni Jan Gofron, M.D.

  • Endocrinology, Diabetes & Metabolism Physician
  • Milwaukee, WI
National Provider Identifier
1871501593
Registry record updated Nov 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
49567 Issued in WI
Practice address
788 N Jefferson St
Suite 201
Milwaukee, WI 53202-3718
Phone
(414) 226-4010
Fax
(414) 274-6270
NPI assigned
Aug 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 49567 WI Primary

Addresses

Primary practice location

788 N Jefferson St
Suite 201
Milwaukee, WI 53202-3718

Mailing address

788 N Jefferson St
Suite 300/Attn. Kaaren Butzen
Milwaukee, WI 53202-3718
Phone (414) 272-8950

Other identifiers 1

IdentifierTypeStateIssuer
1871501593MedicaidWI

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20061208000057 WI Practitioner - Endocrinology 4486653052 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Endocrinology
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Columbia St Marys Hospital Milwaukee IncGroup PAC ID 5890604722, 311 clinicians
Madison Medical Affiliates IncGroup PAC ID 5991606337, 86 clinicians

Practice addresses (Care Compare)

2323 S 102ND St
West Allis, WI 53227-2103
Phone (414) 541-9900

788 N Jefferson St
Suite 201
Milwaukee, WI 53202-3710
Phone (414) 272-8950

801 S 70TH St
West Allis, WI 53214-3147
Phone (414) 773-6600

Hospital & facility affiliations

  • Ascension Columbia St Marys Hospital Milwaukee Hospital, Milwaukee, WI, CCN 520051
  • Ascension SE Wisconsin Hospital Hospital, Milwaukee, WI, CCN 520136
  • Ascension All Saints Hospital Hospital, Racine, WI, CCN 520096

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
49567WIMDEndocrinology, Diabetes & Metabolism Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wisconsin Health Fund CurrentSince Dec 1, 2006 Accepting new patients
Columbia St. Mary'S Hospital Milwaukee, Inc Current Accepting new patients
Columbia St. Mary'S Hospital Milwaukee, Inc CurrentSince May 22, 2007 Accepting new patients
Madison Medical Affiliates, Inc. CurrentSince Nov 1, 2006 Accepting new patients
Columbia St. Mary'S Hospital Milwaukee Inc CurrentSince May 22, 2007 Accepting new patients

Locations

7423 Solutions Ctr
Chicago, IL 60677

13133 N Port Washington Rd
Ste G01
Mequon, WI 53097
Phone (262) 243-2500

788 N Jefferson St
Ste 300ATTN
Milwaukee, WI 53202

788 N Jefferson St
Ste 401
Milwaukee, WI 53202
Phone (414) 226-4020

788 N Jefferson St
Ste 201
Milwaukee, WI 53202
Phone (414) 226-4010

6200 W Bluemound Rd
Milwaukee, WI 53213
Phone (414) 479-3668

2323 S 102nd St
West Allis, WI 53227
Phone (414) 541-9900

801 S 70th St
West Allis, WI 53214
Phone (414) 773-6600

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/11299/brand/1/csg/1/fhir/r4

Organizations & group practices 5

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478649600000",
    "number": "1871501593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "788 N JEFFERSON ST",
            "address_2": "SUITE 300/ATTN. KAAREN BUTZEN",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532023718",
            "telephone_number": "414-272-8950",
            "fax_number": "414-272-0859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "788 N JEFFERSON ST",
            "address_2": "SUITE 201",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532023718",
            "telephone_number": "414-226-4010",
            "fax_number": "414-274-6270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOFRON",
        "first_name": "ANTONI",
        "middle_name": "JAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-05",
        "last_updated": "2016-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "WI",
            "license": "49567",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1871501593",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.