Nicholas Emile Maldonado

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

7547-23 Issued in WI

Practice address

307 Highland Rd
Grayslake, IL 60030-1228

Phone

(847) 757-8037

NPI assigned

Jan 17, 2023

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Vituity-Wisconsin HM SCGroup PAC ID 4880056126, 29 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Froedtert South Inc. Hospital, Kenosha, WI, CCN 520021

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Interoperability endpoints

• Direct secure messaging: nmaldonadoapnpastudent615138@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 and National Provider Directory roles.

• Vituity-Wisconsin HM SC

  • Hospitalist Physician
  • Pleasant Prairie, WI
  • NPI 1679265912
  Medicare reassignment Care Compare group

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

• Froedtert South, Inc.

  • General Acute Care Hospital
  • Pleasant Prairie, WI
  • NPI 1003831132
  Care Compare affiliation

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

{
    "created_epoch": "1673913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691971200000",
    "number": "1992410757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 HIGHLAND RD",
            "city": "GRAYSLAKE",
            "state": "IL",
            "postal_code": "600301228",
            "telephone_number": "847-757-8037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 HIGHLAND RD",
            "city": "GRAYSLAKE",
            "state": "IL",
            "postal_code": "600301228",
            "telephone_number": "847-757-8037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALDONADO",
        "first_name": "NICHOLAS",
        "middle_name": "EMILE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-01-17",
        "last_updated": "2023-08-14",
        "certification_date": "2023-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WI",
            "license": "7547-23",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tracy N Lyndon
• Kelly Jean Lynn, M.S.
• Emma A Macdougall, LCPC, ATR-BC
• Hetty M. Macdowell, LMT
• Ariel Magallon, MD
• Krithika Malhotra, PHD
• Jordan Mallery
• Robert G Malloy, MD
• Manjote K Dhaliwal DDS PC
• Anna Maria Mankowska, M.A.

• Medical Physician Assistant in Grayslake, IL
• Providers in Grayslake, IL by specialty
• Medical Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2023; 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.