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Active NPI 1457004517 Individual Practitioner Male Practitioner

Ryan Otto

Physician Assistant • Kenosha, WI

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Ryan Otto is a certified Physician Assistant practicing in Kenosha, WI. With approximately 4 years of clinical experience since completing medical education in 2022, Ryan Otto delivers high-quality medical care to the local community at 1400 43RD ST.

Ryan Otto is affiliated with Prohealth Medical Group Inc and accepts Medicare assignment.

Practice Location & Contact Primary Location

Practice Address

1400 43rd St

Kenosha, WI 531402741

Telephone 4146512814

Medicare Profile & Education

Medical School

Other

Graduation Year

2022

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Physician Assistant in Kenosha, WI

Rising Specialist (<5 Yrs)
Practitioner Clinical Experience
4 Yrs -10.6 yrs vs City Avg
City Avg: 14.6 Yrs
State Avg: 14.1 Yrs
Regional Practice Density
45 Specialists

Practicing in Kenosha, WI (3517 Statewide)

Telehealth Adoption Rate
13.3% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Otto (4 Years) 4 Yrs
Kenosha Specialty Average (14.6 Years) 14.6 Yrs

Medical Specialties & State Licenses

CMS Verified: 2026-03-16
Physician Assistant Primary Specialty

NUCC Taxonomy Code: 363A00000X

State License WI 8206

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Physician Assistant - Medical

NUCC Taxonomy Code: 363AM0700X

State License IL IL

Definition to come...

Hospital & Practice Group Affiliations

Prohealth Medical Group Inc

725 American Ave, Waukesha, WI 531885031

Phone: 2629287276

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) August 17, 2022

Physician Assistant (License #IL in IL)

NPI Profile Active January 30, 2022

NPI status registered as active in NPPES database

📍
Updated Practice Location January 30, 2022

Registered at 1400 43RD ST, KENOSHA, WI 531402741 (Tel: 4146512814)

📍
Updated Business Mailing Address January 30, 2022

Registered at 1400 43RD ST, KENOSHA, WI 531402741 (Tel: 4146512814)

👤
Provider Name / Credentials Updated January 30, 2022

Recorded as RYAN OTTO

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) January 30, 2022

Student in an Organized Health Care Education/Training Program

🟢
Initial NPI Registration & Enumeration January 30, 2022

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1457004517
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: January 30, 2022
Last Update: March 16, 2026
Sole Proprietor: No

Mailing Address

1400 43rd St

Kenosha, WI 531402741

Phone: 4146512814

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.