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NPI 1710395058ActiveIndividual· Physician Assistant, Medical· Watertown, WI
Physician Assistant, Medical with Watertown Physician Practices LLC, practicing in Watertown, Wisconsin. Their prescriptions cost Medicare Part D more than their services did: $383,693 for 5,443 claims, against $42,015 paid for services in 2024. Lists Watertown Memorial Hospital and 1 other hospital as hospital affiliations.
Overview
| NPI | 1710395058 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Sole proprietor | No |
| NPI issued | Jul 30, 2014 |
| Last updated in NPPES | Dec 16, 2014 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physician Assistant, Medical Primary | 363AM0700X | 3398-23 | WI |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Physician Assistant (WI) |
|---|---|
| Accepts assignment | Yes (participating) |
Medicare services in 2024
| Medicare patients | 207 |
|---|---|
| Services billed | 863 across 35 procedure codes |
| Paid by Medicare | $42,015 |
Part D prescriptions in 2024
| Prescriptions (claims) | 5,443 · 11,857 30-day fills |
|---|---|
| Patients | 360 |
| Total drug cost | $383,693 |
| Generic share | 86% of claims |
Education and affiliations
| Graduation year | 2014 |
|---|---|
| Medicare specialty | Physician Assistant |
| Telehealth | Offers telehealth |
Medical group
- Watertown Physician Practices LLCWatertown, WI · 67 clinicians
Hospital affiliations
- Watertown Memorial HospitalWatertown, WI
- Waukesha Memorial HospitalWaukesha, WI
Other facilities
- Commonheart Home HealthHome health agency · Waukesha, WI
- Agrace HospicecareHospice · Madison, WI
- Rainbow Hospice CareHospice · Jefferson, WI
Industry payments (Open Payments)
None reported for 2025 or 2024.
Receiving payments does not imply wrongdoing. What Open Payments covers ·original records
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