NPIMap

Individual provider Active NPI

Dragana Durdevic

  • Internal Medicine Physician
  • Marinette, WI
National Provider Identifier
1053969600
Registry record updated Nov 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
77046-20 Issued in WI
Practice address
4061 Old Peshtigo Rd
Marinette, WI 54143-3887
Phone
(715) 732-8000
NPI assigned
Aug 27, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X 77046-20 WI Primary

Addresses

Primary practice location

4061 Old Peshtigo Rd
Marinette, WI 54143-3887

Mailing address

4061 Old Peshtigo Rd
Marinette, WI 54143-3887
Phone (715) 732-8000

Other practice location 1

16 Guion Pl
New Rochelle, NY 10801-5502
Phone (914) 365-3680

Other identifiers 1

IdentifierTypeStateIssuer
100205652MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address ddurdevic333200@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
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220725001312 WI Practitioner - Internal Medicine 2466833363 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2016
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

3301 W Forest Home Ave
Milwaukee, WI 53215-2843

Hospital & facility affiliations

  • Aurora at Home Home health agency, Green Bay, WI, CCN 527302
  • Up Health System Home Care and Hospice Home health agency, Marquette, MI, CCN 237093
  • Aurora Medical Center Bay Area Hospital, Marinette, WI, CCN 520113
  • Aurora Baycare Medical Ctr Hospital, Green Bay, WI, CCN 520193

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Medical Group, Inc. CurrentSince Jul 1, 2022 Accepting new patients
Aurora Medical Group, Inc. Internal Medicine CurrentSince Jul 1, 2022 Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients

Locations

4061 Old Peshtigo Rd
Marinette, WI 54143
Phone (715) 732-8000

3301 W Forest Home Ave
Milwaukee, WI 53215
Phone (414) 389-2233

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

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 6

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": "1566864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668556800000",
    "number": "1053969600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4061 OLD PESHTIGO RD",
            "city": "MARINETTE",
            "state": "WI",
            "postal_code": "541433887",
            "telephone_number": "715-732-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4061 OLD PESHTIGO RD",
            "city": "MARINETTE",
            "state": "WI",
            "postal_code": "541433887",
            "telephone_number": "715-732-8000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16 Guion Pl",
            "address_purpose": "LOCATION",
            "city": "New Rochelle",
            "state": "NY",
            "postal_code": "108015502",
            "country_code": "US",
            "telephone_number": "914-365-3680",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DURDEVIC",
        "first_name": "DRAGANA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-27",
        "last_updated": "2022-11-16",
        "certification_date": "2022-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "77046-20",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100205652",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ddurdevic333200@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "4061 Old Peshtigo Rd",
            "city": "Marinette",
            "state": "WI",
            "country_code": "US",
            "postal_code": "541433887",
            "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": "4061 Old Peshtigo Rd",
            "city": "Marinette",
            "state": "WI",
            "country_code": "US",
            "postal_code": "541433887",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Marinette, WI

Sources for this page

Verify at the official NPI Registry.