Individual provider Active NPI

Amber Hildebrandt, M.D.

  • Family Medicine Physician
  • Hartford, WI
National Provider Identifier
1003889643
Registry record updated Apr 1, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
45460 Issued in WI
Practice address
110 Lone Oak LN
Hartford, WI 53027-2600
Phone
(262) 670-1800
NPI assigned
Feb 13, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 45460 WI Primary

Addresses

Primary practice location

110 Lone Oak LN
Hartford, WI 53027-2600

Mailing address

1700 W Paradise Dr
West Bend, WI 53095-9795
Phone (262) 334-3451

Other identifiers 1

IdentifierTypeStateIssuer
34419800MedicaidWI

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040731000091 WI Practitioner - Family Practice 2466422829 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
45460WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ascension Medical Group-Southeast Wisconsin Inc Family Medicine CurrentSince Jan 11, 2014 Accepting new patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. Past Accepting new patients

Locations

13950 W Capitol Dr
Brookfield, WI 53005
Phone (414) 302-5400

1292 Capitol Dr
Pewaukee, WI 53072
Phone (262) 695-7373

201 N Mayfair Rd
Fl 2
Wauwatosa, WI 53226
Phone (414) 771-8228

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1139788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1364774400000",
    "number": "1003889643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 W PARADISE DR",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530959795",
            "telephone_number": "262-334-3451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 LONE OAK LN",
            "city": "HARTFORD",
            "state": "WI",
            "postal_code": "530272600",
            "telephone_number": "262-670-1800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HILDEBRANDT",
        "first_name": "AMBER",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-13",
        "last_updated": "2013-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "45460",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34419800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hartford, WI

Sources for this page

Verify at the official NPI Registry.