Active NPI
Keith J Hacker, P.A.
- Physician Assistant
- Port Washington, WI
National Provider Identifier
1952508400
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 523
- Practice address
- 1777 W Grand Ave
Port Washington, WI 53074-2077 - Phone
- (262) 284-3456
- NPI assigned
- Jun 28, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 523 | WI | Primary |
Addresses
Primary practice location
1777 W Grand Ave
Port Washington, WI 53074-2077
Mailing address
1777 W Grand Ave
Port Washington, WI 53074-2077
Phone (262) 284-3456
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952508400 | Medicaid | WI |
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | khacker182621@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
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Interoperability endpoints
- khacker182621@direct.myadvocateaurora.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182988800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1637625600000",
"number": "1952508400",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1777 W GRAND AVE",
"city": "PORT WASHINGTON",
"state": "WI",
"postal_code": "530742077",
"telephone_number": "262-284-3456"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1777 W GRAND AVE",
"city": "PORT WASHINGTON",
"state": "WI",
"postal_code": "530742077",
"telephone_number": "262-284-3456"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HACKER",
"first_name": "KEITH",
"middle_name": "J",
"name_prefix": "Mr.",
"credential": "P.A.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-06-28",
"last_updated": "2021-11-23",
"certification_date": "2021-11-23",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WI",
"license": "523",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1952508400",
"state": "WI"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "khacker182621@direct.myadvocateaurora.org",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "1777 W Grand Ave",
"city": "Port Washington",
"state": "WI",
"country_code": "US",
"postal_code": "530742077",
"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": "1777 W Grand Ave",
"city": "Port Washington",
"state": "WI",
"country_code": "US",
"postal_code": "530742077",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Port Washington, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.