Mellisa Yu Koenings, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

3842-23 Issued in WI

Practice address

1155 N Mayfair Rd
Wauwatosa, WI 53226-3462

Phone

(414) 955-5990

Fax

(414) 955-6282

NPI assigned

Jul 21, 2016

Last updated

Jan 4, 2024By the provider in NPPES

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

Other identifiers 1

Other names 1

• Mellisa Min Yu Former name

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

Telehealth

Offers telehealth services

Group practices

The Medical College of Wisconsin IncGroup PAC ID 2668384371, 2,092 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Froedtert Memorial Lutheran Hospital Hospital, Milwaukee, WI, CCN 520177
• Holy Family Memorial Hospital, Manitowoc, WI, CCN 520107

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: myupa201041@direct.froedtert.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• The Medical College of Wisconsin, Inc.

  • Internal Medicine Physician
  • Milwaukee, WI
  • NPI 1699720086
  Medicare reassignment Care Compare group
• Froedtert &the Medical College of Wisconsin Community Physicians, Inc.

  • Internal Medicine Physician
  • Menomonee Falls, WI
  • NPI 1568787448
  Medicare reassignment NPD
• Moreland Ear Nose & Throat Group LTD

  • Specialist
  • Waukesha, WI
  • NPI 1861464182
  Medicare reassignment
• DRS. Massaro & Kalenak S C

  • Ophthalmology Physician
  • Milwaukee, WI
  • NPI 1558482364
  NPD
• Froedtert &the Medical College of Wisconsin Community Physicians, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Wauwatosa, WI
  • NPI 1154947224
  NPD

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

• Froedtert Memorial Lutheran Hospital, Inc.

  dba CDI-Froedtert Memorial Lutheran Hospital

  • General Acute Care Hospital
  • Milwaukee, WI
  • NPI 1255334173
  Care Compare affiliation
• Holy Family Memorial Inc

  dba Froedtert Holy Family Memorial Hospital

  • General Acute Care Hospital
  • Manitowoc, WI
  • NPI 1700998697
  Care Compare affiliation

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

{
    "created_epoch": "1469059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704326400000",
    "number": "1912350208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1155 N MAYFAIR RD",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532263462",
            "telephone_number": "414-955-5990",
            "fax_number": "414-955-6282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1155 N MAYFAIR RD",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532263462",
            "telephone_number": "414-955-5990",
            "fax_number": "414-955-6282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOENINGS",
        "first_name": "MELLISA",
        "middle_name": "YU",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-21",
        "last_updated": "2024-01-04",
        "certification_date": "2024-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "3842-23",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1912350208",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MELLISA",
            "last_name": "YU",
            "middle_name": "MIN",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Zachary Koba, PTA
• Julie Anne Koch, M.S.
• Matthew Joseph Koch, DPT
• Rachael Koch
• Rajiv Kodali, MD
• Jamie Nicole Koepke
• Katie A Koester, MPT
• Paul Koester, LPC, CSAC
• Stephanie L Kohler-Neuwirth
• Annaliese Marie Koller Shumate, D.O.

• Physician Assistant in Wauwatosa, WI
• Providers in Wauwatosa, 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, 2024; 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.