Individual provider Active NPI

Abdel Aziz Ahmad Jaffan, M.D.

  • Vascular & Interventional Radiology Physician
  • Grafton, WI
National Provider Identifier
1871799304
Registry record updated Aug 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
License
64340-20 Issued in WI
Practice address
975 Port Washington Rd
Grafton, WI 53024-9204
Phone
(262) 329-1000
Fax
(262) 329-1001
NPI assigned
Jun 22, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular & Interventional Radiology Physician 2085R0204X 64340-20 WI Primary

Addresses

Primary practice location

975 Port Washington Rd
Grafton, WI 53024-9204

Mailing address

PO Box 735044
Chicago, IL 60673-5044

Other identifiers 1

IdentifierTypeStateIssuer
100025682MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address ajaffan168933@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, WI2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20120706000508 GA Practitioner - Diagnostic RadiologyPractitioner - Interventional Radiology 2264584747 Reassigns benefits to 2 organizations
I20151013000178 WI Practitioner - Diagnostic RadiologyPractitioner - Interventional Radiology 2264584747 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic RadiologyAlso: Interventional Radiology
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aurora Advanced Healthcare, Inc.Group PAC ID 3375625833, 1,107 clinicians
Lakeshore Medical Clinic LLCGroup PAC ID 7719890730, 375 clinicians
Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians

Practice addresses (Care Compare)

1640 E Sumner St
Hartford, WI 53027-2684
Phone (262) 670-4000

2000 E Layton Ave
Suite 130
St Francis, WI 53235-6067
Phone (414) 747-8856

975 Port Washington Rd
Grafton, WI 53024-9204
Phone (262) 329-8650

Hospital & facility affiliations

  • Aurora Medical Center Hospital, Grafton, WI, CCN 520207
  • Aurora St Lukes Medical Center Hospital, Milwaukee, WI, CCN 520138
  • Aurora Medical Center Sheboygan County Hospital, Sheboygan, WI, CCN 520035
  • Aurora Memorial Hospital Burlington Hospital, Burlington, WI, CCN 520059
  • Aurora Medical Center Kenosha Hospital, Kenosha, WI, CCN 520189

Procedures performed for Medicare patients

ProcedureNumber of procedures
Varicose vein removal14
Leg revascularization (restoring blood flow)1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
64340-20WIMDVascular & Interventional Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emory Medical Care Foundation Inc Diagnostic Radiology CurrentSince Jul 1, 2012 Accepting new patients
Aurora Advanced Healthcare, Inc. CurrentSince Oct 26, 2015 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Oct 26, 2015 Accepting new patients
Lakeshore Medical Clinic, LLC CurrentSince Oct 26, 2015 Accepting new patients
Aurora Advanced Healthcare Inc CurrentSince Oct 26, 2015 Accepting new patients
The Emory Clinic Inc Diagnostic Radiology CurrentSince Jul 1, 2012 Accepting new patients
Aurora Medical Group, Inc. Diagnostic Radiology CurrentSince Oct 26, 2015 Accepting new patients
Emory Medical Care Foundation Inc CurrentSince Jul 1, 2012 Accepting new patients

Locations

80 Jesse Hill Jr Dr SE
Atlanta, GA 30303
Phone (404) 616-4370

1365 Clifton Rd NE
Atlanta, GA 30322
Phone (404) 778-7525

101 W Ponce de Leon Ave
Ste 300
Decatur, GA 30030
Phone (404) 778-4889

112 N US Highway 141
Crivitz, WI 54114
Phone (715) 735-6621

3003 W Good Hope Rd
Glendale, WI 53209
Phone (414) 352-3100

975 Port Washington Rd
Grafton, WI 53024
Phone (262) 329-1000

1640 E Sumner St
Hartford, WI 53027
Phone (262) 670-4000

3003 University Dr
Marinette, WI 54143
Phone (715) 735-4200

4061 Old Peshtigo Rd
Marinette, WI 54143
Phone (715) 732-8000

12203 N Corporate Pkwy
Mequon, WI 53092
Phone (262) 387-8200

2900 W Oklahoma Ave
Milwaukee, WI 53215
Phone (414) 385-2590

1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056

S74W16775 Janesville Rd
Muskego, WI 53150
Phone (414) 422-4747

2000 E Layton Ave
Ste 130
St Francis, WI 53235
Phone (414) 747-8856

2000 E Layton Ave
St Francis, WI 53235
Phone (414) 744-7880

4025 N 92nd St
Wauwatosa, WI 53222
Phone (414) 358-5431

Interoperability endpoints

  • Direct secure messaging: ajaffan168933@direct.myadvocateaurora.org

Organizations & group practices 8

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 7

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": "1182470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691625600000",
    "number": "1871799304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 735044",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606735044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "975 PORT WASHINGTON RD",
            "city": "GRAFTON",
            "state": "WI",
            "postal_code": "530249204",
            "telephone_number": "262-329-1000",
            "fax_number": "262-329-1001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAFFAN",
        "first_name": "ABDEL AZIZ",
        "middle_name": "AHMAD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-22",
        "last_updated": "2023-08-10",
        "certification_date": "2023-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "WI",
            "license": "64340-20",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100025682",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ajaffan168933@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "4025 N 92nd St",
            "city": "Wauwatosa",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532221613",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "4025 N 92nd St",
            "city": "Wauwatosa",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532221613",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Grafton, WI

Sources for this page

Verify at the official NPI Registry.