Individual provider Active NPI

Catherine Martha De Grandville, MD

  • Family Medicine Physician
  • Milwaukee, WI
National Provider Identifier
1023299765
Registry record updated Jan 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
52841-20 Issued in WI
Practice address
2801 W Kinnickinnic River Pkwy
Suite 250
Milwaukee, WI 53215-3669
Phone
(414) 649-6732
NPI assigned
Nov 23, 2007
Last updated
Jan 22, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2024

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 52841-20 WI Primary

Addresses

Primary practice location

2801 W Kinnickinnic River Pkwy
Suite 250
Milwaukee, WI 53215-3669

Mailing address

2801 W Kinnickinnic River Pkwy
Suite 250
Milwaukee, WI 53215-3669
Phone (414) 649-6732

Other identifiers 1

IdentifierTypeStateIssuer
100011746MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address cdegrandville23182@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

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
I20110321001053 WI Practitioner - Family Practice 8527241033 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians

Practice addresses (Care Compare)

W3985 County Rd NN
Elkhorn, WI 53121-4337
Phone (262) 741-2000

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Medical Group, Inc. CurrentSince Aug 1, 2017 Accepting new patients
Aurora Medical Group, Inc. Family Medicine Current Accepting new patients
Aurora Medical Group, Inc. CurrentSince Aug 1, 2017 Accepting new patients
Aurora Health Care Metro, Inc. Family Medicine CurrentSince Oct 18, 2011 Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients

Locations

W3985 Highway NN
Elkhorn, WI 53121
Phone (262) 741-2000

1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056

2801 W Kinnickinnic River Pkwy
Ste 250
Milwaukee, WI 53215
Phone (414) 649-3354

2900 W Oklahoma Ave
Milwaukee, WI 53215
Phone (414) 385-2590

Interoperability endpoints

  • Direct secure messaging: cdegrandville23182@direct.myadvocateaurora.org

Organizations & group practices 5

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 2

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": "1195776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705881600000",
    "number": "1023299765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 W KINNICKINNIC RIVER PKWY",
            "address_2": "SUITE 250",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532153669",
            "telephone_number": "414-649-6732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 W KINNICKINNIC RIVER PKWY",
            "address_2": "SUITE 250",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532153669",
            "telephone_number": "414-649-6732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE GRANDVILLE",
        "first_name": "CATHERINE",
        "middle_name": "MARTHA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-23",
        "last_updated": "2024-01-22",
        "certification_date": "2024-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "52841-20",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100011746",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cdegrandville23182@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2801 W Kinnickinnic River Pkwy",
            "address_2": "suite 250",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532153669",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "2801 W Kinnickinnic River Pkwy",
            "address_2": "suite 250",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532153669",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.