Individual provider Active NPI

Kathryn R Trandem, MD, PHD

  • Urology Physician
  • Boscobel, WI
National Provider Identifier
1053674770
Registry record updated Apr 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
73669 Issued in WI
Practice address
205 Parker St
Boscobel, WI 53805-1642
Phone
(608) 375-4112
NPI assigned
Jun 18, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 036.154905 IL
Pediatric Urology Physician 2088P0231X 73669 WI
Urology Physician 208800000X 73669 WI Primary

Addresses

Primary practice location

205 Parker St
Boscobel, WI 53805-1642

Mailing address

9000 W Wisconsin Ave
Milwaukee, WI 53226-4874
Phone (414) 266-3794

Other practice location 1

9000 W Wisconsin Ave
Milwaukee, WI 53226-4874
Phone (414) 266-3794

Other practice location 2

2575 E Evergreen Drive
Appleton, WI 54913-8904
Phone (920) 969-5353

Other practice location 3

1506 S Oneida St Ste 500
Appleton, WI 54915-1305
Phone (920) 969-9700

Other practice location 4

1675 Dempster St Fl 3
Park Ridge, IL 60068-1110
Phone (847) 297-8700

Other identifiers 1

IdentifierTypeStateIssuer
1053674770MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/
Direct Messaging Address ktrandem395283@direct.myadvocateaurora.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, WI, IL3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20180724003402 CA Practitioner - Urology 1557618378 Reassigns benefits to 2 organizations
I20200910000668 WI Practitioner - Urology 1557618378 Reassigns benefits to 3 organizations
I20230824002555 IL Practitioner - Urology 1557618378 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036.154905ILMDUrology Physician
73669WIMDPediatric Urology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Family Healthcare Network CurrentSince Dec 18, 2020 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Memorial Hospital of Boscobel CurrentSince Nov 13, 2023 Accepting new patients
Family Healthcare Network CurrentSince Dec 18, 2020 Accepting new patients
The Medical College of Wisconsin, Inc. Surgery CurrentSince Aug 1, 2020 Accepting new patients
Advocate Health and Hospitals Corporation CurrentSince Jan 26, 2024 Accepting new patients
Advocate Health and Hospitals Corporation Current Accepting new patients
Osf Multi-Specialty Group CurrentSince Aug 10, 2023 Accepting new patients
Family Healthcare Network Current Accepting new patients
Advocate Health and Hospitals Corporation CurrentSince Jan 26, 2024 Accepting new patients
UCSF Medical Group Business Services CurrentSince Jul 1, 2018 Accepting new patients
UCSF Medical Group Business Services Surgery CurrentSince Jul 1, 2018 Accepting new patients
Memorial Hospital of Boscobel CurrentSince Nov 13, 2023 Accepting new patients

Locations

290 N Wayte Ln
Fresno, CA 93701
Phone (559) 459-4101

2330 Post St
San Francisco, CA 94115
Phone (415) 502-4444

400 Parnassus Ave
#A632
San Francisco, CA 94143
Phone (415) 473-1000

400 Parnassus Ave
#300
San Francisco, CA 94143
Phone (415) 476-2163

400 Parnassus Ave
San Francisco, CA 94143
Phone (415) 353-2000

3333 California St
#S110
San Francisco, CA 94118
Phone (415) 514-2664

305 E Center Ave
Visalia, CA 93291
Phone (559) 737-4792

214 McHenry Rd
Buffalo Grove, IL 60089
Phone (847) 459-1160

29373 Network Pl
Chicago, IL 60673

1675 W Dempster St
Fl 3
Park Ridge, IL 60068
Phone (847) 318-9330

1675 W Dempster St
Park Ridge, IL 60068
Phone (847) 318-9300

420 NE Glen Oak Ave
Ste 201
Peoria, IL 61603
Phone (309) 655-3800

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

1506 S Oneida St
Ste 500
Appleton, WI 54915
Phone (920) 738-8050

205 Parker St
Boscobel, WI 53805
Phone (608) 375-4112

9000 W Wisconsin Ave
Wauwatosa, WI 53226
Phone (414) 266-2625

8701 Watertown Plank Rd
Wauwatosa, WI 53226
Phone (414) 456-4100

Interoperability endpoints

  • Direct secure messaging: ktrandem822974@direct.emplifyhealth.org

Organizations & group practices 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1339977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712275200000",
    "number": "1053674770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9000 W WISCONSIN AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532264874",
            "telephone_number": "414-266-3794",
            "fax_number": "414-266-1752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 PARKER ST",
            "city": "BOSCOBEL",
            "state": "WI",
            "postal_code": "538051642",
            "telephone_number": "608-375-4112"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9000 W Wisconsin Ave",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532264874",
            "country_code": "US",
            "telephone_number": "414-266-3794",
            "fax_number": "414-266-1752",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2575 E Evergreen Drive",
            "address_purpose": "LOCATION",
            "city": "Appleton",
            "state": "WI",
            "postal_code": "549138904",
            "country_code": "US",
            "telephone_number": "920-969-5353",
            "fax_number": "414-337-7201",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1506 S Oneida St Ste 500",
            "address_purpose": "LOCATION",
            "city": "Appleton",
            "state": "WI",
            "postal_code": "549151305",
            "country_code": "US",
            "telephone_number": "920-969-9700",
            "fax_number": "920-969-7979",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1675 Dempster St Fl 3",
            "address_purpose": "LOCATION",
            "city": "Park Ridge",
            "state": "IL",
            "postal_code": "600681110",
            "country_code": "US",
            "telephone_number": "847-297-8700",
            "fax_number": "847-723-9441",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TRANDEM",
        "first_name": "KATHRYN",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "MD, PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-18",
        "last_updated": "2024-04-05",
        "certification_date": "2024-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "IL",
            "license": "036.154905",
            "primary": false
        },
        {
            "code": "2088P0231X",
            "taxonomy_group": "",
            "desc": "Urology, Pediatric Urology",
            "state": "WI",
            "license": "73669",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "WI",
            "license": "73669",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1053674770",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "1675 Dempster St Fl 3",
            "city": "Park Ridge",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600681110",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ktrandem395283@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1675 Dempster St Fl 3",
            "city": "Park Ridge",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600681110",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Boscobel, WI

Sources for this page

Verify at the official NPI Registry.