Mikayla Lynn Boettner, APNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

13437 Issued in WI

Practice address

1305 W Main St
Whitewater, WI 53190-1503

Phone

(262) 473-4548

Fax

(262) 472-7691

NPI assigned

Feb 24, 2023

Last updated

Mar 2, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 2

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

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Oak Medical SCGroup PAC ID 0042595175, 118 clinicians

Maple Medical SCGroup PAC ID 9032471248, 25 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Cedar Crest Health Center Nursing home, Janesville, WI, CCN 525649

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mboettner445223@direct-ehr-ssmhc.com

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.

• Maple Medical SC

  • Physical Medicine & Rehabilitation Physician
  • Waukesha, WI
  • NPI 1487152104
  Medicare reassignment Care Compare group NPD
• Oak Medical SC

  • Internal Medicine Physician
  • Waukesha, WI
  • NPI 1669910345
  Medicare reassignment Care Compare group NPD
• Dean Health Systems, Inc

  dba SSM Health Dean Medical Group

  • Allergy & Immunology Physician
  • Madison, WI
  • NPI 1053358846
  Medicare reassignment NPD
• Dean Health Systems, Inc.

  dba SSM Health Davis Duehr Dean Eye Care - Portage

  • Durable Medical Equipment & Medical Supplies
  • Portage, WI
  • NPI 1427085679
  NPD

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

• Cedar Crest, Inc.

  • Skilled Nursing Facility
  • Janesville, WI
  • NPI 1831171610

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1677196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677715200000",
    "number": "1013616473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1305 W MAIN ST",
            "city": "WHITEWATER",
            "state": "WI",
            "postal_code": "531901503",
            "telephone_number": "262-473-4548",
            "fax_number": "262-472-7691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1305 W MAIN ST",
            "city": "WHITEWATER",
            "state": "WI",
            "postal_code": "531901503",
            "telephone_number": "262-473-4548",
            "fax_number": "262-472-7691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOETTNER",
        "first_name": "MIKAYLA",
        "middle_name": "LYNN",
        "credential": "APNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-24",
        "last_updated": "2023-03-02",
        "certification_date": "2023-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "13437",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mboettner445223@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "mboettner445223@direct-ehr-ssmhc.com",
            "address_1": "1305 W Main St",
            "city": "Whitewater",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531901503",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "1305 W Main St",
            "city": "Whitewater",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531901503",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kimberly Bavis
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• Ryatisima Tishara Blue, LPN
• Lesley Loraine Blum, OT
• Lisa K Brellenthin, APNP
• Cheryl Bresnahan, DDS
• Forrest Lee Bright, DNP
• Patricia Lee Bromley, PH.D.
• Brotoloc Inc. Outpatient Clinic (Brotoloc)

• Nurse Practitioner in Whitewater, WI
• Providers in Whitewater, WI by specialty
• Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 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.