Individual provider Active NPI

Vanessa Riley Klein

  • Physician Assistant
  • Milwaukee, WI
National Provider Identifier
1073216917
Registry record updated Aug 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
7404 Issued in WI
Practice address
2323 N Lake Dr
Milwaukee, WI 53211-4508
Phone
(414) 291-1000
NPI assigned
Mar 22, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 31, 2023

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
Physician Assistant 363A00000X 7404 WI Primary

Addresses

Primary practice location

2323 N Lake Dr
Milwaukee, WI 53211-4508

Mailing address

2323 N Lake Dr
Milwaukee, WI 53211-4508
Phone (414) 291-1000

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231019002950 WI Practitioner - Physician Assistant 5496101941 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

13111 N Port Washington Rd
Mequon, WI 53097-2416
Phone (262) 243-7300

2301 N Lake Dr
Milwaukee, WI 53211-4508

2323 N Lake Dr
Milwaukee, WI 53211-4508
Phone (414) 585-1000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
7404WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Columbia St. Mary'S Hospital Milwaukee, Inc CurrentSince Aug 4, 2023 Accepting new patients
Columbia St. Mary'S Hospital Milwaukee Inc CurrentSince Aug 4, 2023 Accepting new patients

Locations

2323 N Lake Dr
Milwaukee, WI 53211
Phone (414) 291-1000

2301 N Lake Dr
Milwaukee, WI 53211
Phone (414) 270-4932

13111 N Port Washington Rd
Thiensville, WI 53097
Phone (262) 243-7300

801 S 70th St
West Allis, WI 53214
Phone (414) 773-6600

Organizations & group practices 2

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": "1679443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693440000000",
    "number": "1073216917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2323 N LAKE DR",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532114508",
            "telephone_number": "414-291-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2323 N LAKE DR",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532114508",
            "telephone_number": "414-291-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLEIN",
        "first_name": "VANESSA",
        "middle_name": "RILEY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-03-22",
        "last_updated": "2023-08-31",
        "certification_date": "2023-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "7404",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.