Individual provider Active NPI

Mary Katherine Kautz, APNP

  • Gerontology Nurse Practitioner
  • Mequon, WI
National Provider Identifier
1013152743
Registry record updated Oct 31, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
3526-33 Issued in WI
Practice address
13133 N Port Washington Rd
Suite 122
Mequon, WI 53097-2419
Phone
(262) 243-3700
Fax
(262) 243-3701
NPI assigned
Dec 9, 2008
Last updated
Oct 31, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 3526-33 WI Primary

Addresses

Primary practice location

13133 N Port Washington Rd
Suite 122
Mequon, WI 53097-2419

Mailing address

4425 N Port Washington Rd
Attn: Csmcp Clinic Credentialing
Glendale, WI 53212-1082
Phone (262) 243-3700

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090903000449 WI Practitioner - Nurse Practitioner 4183779796 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

13111 N Port Washington Rd
Mequon, WI 53097-2416
Phone (262) 243-7300

13133 N Port Washington Rd
Suite G06
Mequon, WI 53097-2421
Phone (262) 243-8371

2301 N Lake Dr
Milwaukee, WI 53211-4508

2323 N Lake Dr
Milwaukee, WI 53211-4508
Phone (414) 585-1000

801 S 70TH St
West Allis, WI 53214-3147
Phone (414) 773-6600

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
3526-33WIMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Columbia St. Mary's Hospital Milwaukee, Inc Current Accepting new patients
Columbia St. Mary's Hospital Milwaukee, Inc CurrentSince Jul 26, 2009 Accepting new patients
Columbia St. Mary's Hospital Milwaukee Inc CurrentSince Jul 26, 2009 Accepting new patients
Columbia St. Mary's Hospital Milwaukee, Inc Past Accepting new patients

Locations

13133 N Port Washington Rd
Ste 122
Mequon, WI 53097
Phone (262) 243-3700

13111 N Port Washington Rd
Thiensville, WI 53097
Phone (262) 243-7300

801 S 70th St
West Allis, WI 53214
Phone (414) 773-6600

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1228780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320019200000",
    "number": "1013152743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4425 N PORT WASHINGTON RD",
            "address_2": "ATTN: CSMCP CLINIC CREDENTIALING",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532121082",
            "telephone_number": "262-243-3700",
            "fax_number": "262-243-3701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13133 N PORT WASHINGTON RD",
            "address_2": "SUITE 122",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530972419",
            "telephone_number": "262-243-3700",
            "fax_number": "262-243-3701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAUTZ",
        "first_name": "MARY",
        "middle_name": "KATHERINE",
        "name_prefix": "Mrs.",
        "credential": "APNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-12-09",
        "last_updated": "2011-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "WI",
            "license": "3526-33",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mequon, WI

Sources for this page

Verify at the official NPI Registry.