NPIMap

Individual provider Active NPI

Brooke Elizabeth Kottke

  • Family Nurse Practitioner
  • Wausau, WI
National Provider Identifier
1104695246
Registry record updated Jan 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
14869-33 Issued in WI
Practice address
425 Pine Ridge Blvd Ste 200
Wausau, WI 54401-4123
Phone
(715) 847-2480
NPI assigned
Jan 1, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 1, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 14869-33 WI Primary

Addresses

Primary practice location

425 Pine Ridge Blvd Ste 200
Wausau, WI 54401-4123

Mailing address

244266 Grass Creek LN
Athens, WI 54411-3400
Phone (715) 573-9404

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
I20240119002110 WI Practitioner - Nurse Practitioner 8820440365 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Aspirus Wausau Hospital IncGroup PAC ID 6406757442, 242 clinicians

Practice addresses (Care Compare)

135 S Gibson St
Medford, WI 54451-1622
Phone (715) 847-2611

143 S Gibson St
Medford, WI 54451-1622
Phone (715) 748-2121

333 Pine Ridge Blvd
Wausau, WI 54401-4102

333 Pine Ridge Blvd
Wausau, WI 54401-4120
Phone (715) 847-2121

425 Pine Ridge Blvd
Wausau, WI 54401-4123

501 Aurora St
Antigo, WI 54409-2721
Phone (715) 847-2611

Hospital & facility affiliations

  • Aspirus Wausau Hospital Hospital, Wausau, WI, CCN 520030
  • Aspirus Stevens Point Hospital & Clinics, Inc. Hospital, Stevens Point, WI, CCN 520002
  • Aspirus Rhinelander Hospital Hospital, Rhinelander, WI, CCN 520019
  • Aspirus Medford Hospital & Clinics, Inc Hospital, Medford, WI, CCN 521324

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
14869-33WIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Aspirus Wausau Hospital, Inc. CurrentSince Jan 1, 2024 Accepting new patients
Aspirus Medford Hospital & Clinics, Inc. Current Accepting new patients
Aspirus Medford Hospital & Clinics, Inc. CurrentSince Jan 1, 2024 Accepting new patients
Aspirus Rhinelander & Tomahawk Hospitals & Clinics, Inc. CurrentSince Jan 1, 2024 Accepting new patients
Aspirus Medford Hospital & Clinics, Inc. CurrentSince Jan 1, 2024 Accepting new patients
Aspirus Rhinelander & Tomahawk Hospitals & Clinics, Inc. CurrentSince Jan 1, 2024 Accepting new patients
Aspirus Wausau Hospital, Inc. CurrentSince Jan 1, 2024 Accepting new patients
Aspirus Wausau Hospital, Inc. Current Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

400 W Glen St
Crandon, WI 54520
Phone (715) 478-3318

135 S Gibson St
Medford, WI 54451
Phone (715) 748-8100

2251 N Shore Dr
Ste 100
Rhinelander, WI 54501
Phone (715) 361-2074

401 W Mohawk Dr
Ste 100
Tomahawk, WI 54487
Phone (715) 453-7700

425 Pine Ridge Blvd
Wausau, WI 54401
Phone (715) 847-2400

425 Pine Ridge Blvd
Ste 200
Wausau, WI 54401
Phone (715) 847-0075

333 Pine Ridge Blvd
Wausau, WI 54401
Phone (715) 847-2160

Interoperability endpoints

  • Direct secure messaging: bdraxler122890@direct.aspirus.org

Organizations & group practices 8

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 36

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1704067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704067200000",
    "number": "1104695246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "244266 GRASS CREEK LN",
            "city": "ATHENS",
            "state": "WI",
            "postal_code": "544113400",
            "telephone_number": "715-573-9404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 PINE RIDGE BLVD STE 200",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544014123",
            "telephone_number": "715-847-2480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOTTKE",
        "first_name": "BROOKE",
        "middle_name": "ELIZABETH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-01",
        "last_updated": "2024-01-01",
        "certification_date": "2023-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "14869-33",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wausau, WI

Sources for this page

Verify at the official NPI Registry.