Individual provider Active NPI

Dorothy Katherine Free

  • Certified Registered Nurse Anesthetist
  • Kenosha, WI
National Provider Identifier
1053700682
Registry record updated Apr 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
7903-033 Issued in WI
Practice address
10400 75TH St
Kenosha, WI 53142-8323
Phone
(262) 948-5600
Fax
(262) 948-5735
NPI assigned
Jan 20, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X AP127249 TX
Certified Registered Nurse Anesthetist 367500000X 7903-033 WI Primary

Addresses

Primary practice location

10400 75TH St
Kenosha, WI 53142-8323

Mailing address

10400 75TH St
Kenosha, WI 53142-8323
Phone (262) 948-5600

Other identifiers 1

IdentifierTypeStateIssuer
100072228MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address dfree335753@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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171018001683 WI Practitioner - Certified Registered Nurse Anesthetist (Crna) 3779808134 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2014
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)

10400 75TH St
Kenosha, WI 53142-7884
Phone (262) 948-7000

Hospital & facility affiliations

  • Aurora Medical Center Kenosha Hospital, Kenosha, WI, CCN 520189

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
AP127249TXMDCertified Registered Nurse Anesthetist
7903-033WIMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Medical Group, Inc. CurrentSince Apr 1, 2022 Accepting new patients
Aurora Medical Group, Inc. Nurse Anesthetist, Certified Registered Current Accepting new patients
Aurora Medical Group, Inc. CurrentSince Apr 1, 2022 Accepting new patients

Locations

10400 75th St
Kenosha, WI 53142
Phone (262) 697-7000

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

9200 W Wisconsin Ave
Wauwatosa, WI 53226
Phone (414) 259-3000

Organizations & group practices 3

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.

Hospital & facility affiliations 1

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": "1421712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649894400000",
    "number": "1053700682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10400 75TH ST",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531428323",
            "telephone_number": "262-948-5600",
            "fax_number": "262-948-5735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10400 75TH ST",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531428323",
            "telephone_number": "262-948-5600",
            "fax_number": "262-948-5735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREE",
        "first_name": "DOROTHY",
        "middle_name": "KATHERINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-01-20",
        "last_updated": "2022-04-14",
        "certification_date": "2022-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TX",
            "license": "AP127249",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "WI",
            "license": "7903-033",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100072228",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dfree335753@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "10400 75th St",
            "city": "Kenosha",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531428323",
            "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": "10400 75th St",
            "city": "Kenosha",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531428323",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kenosha, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.