NPIMap

Individual provider Active NPI

Russell Blankenburg, MD

  • Internal Medicine Physician
  • Brookfield, WI
National Provider Identifier
1104893577
Registry record updated Dec 7, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
35536 Issued in WI
Practice address
17000 W North Ave
Suite 200E
Brookfield, WI 53005-4423
Phone
(262) 782-4270
Fax
(262) 784-9319
NPI assigned
Mar 3, 2006
Last updated
Dec 7, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 35536 WI Primary

Addresses

Primary practice location

17000 W North Ave
Suite 200E
Brookfield, WI 53005-4423

Mailing address

17000 W North Ave
Brookfield, WI 53005-4423
Phone (262) 782-4270

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
I20040504000957 WI Practitioner - Internal Medicine 1850389214 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Wisconsin School of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

17000 W N Ave
Suite 104W
Brookfield, WI 53005-4423
Phone (262) 785-1500

Hospital & facility affiliations

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 Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Ascension Medical Group-Southeast Wisconsin Inc Internal Medicine CurrentSince Oct 1, 2010 Accepting new patients
Ascension All Saints Hospital, Inc Past Accepting new patients

Locations

13950 W Capitol Dr
Brookfield, WI 53005
Phone (414) 302-5400

17000 W North Ave
Ste 104W
Brookfield, WI 53005
Phone (262) 395-4141

17000 W North Ave
Ste 200E
Brookfield, WI 53005
Phone (262) 594-2946

2205 N Calhoun Rd
Brookfield, WI 53005
Phone (262) 782-3120

3821 Spring St
Mount Pleasant, WI 53405
Phone (262) 687-8460

201 N Mayfair Rd
Fl 2
Wauwatosa, WI 53226
Phone (414) 771-8228

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1141344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1260144000000",
    "number": "1104893577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17000 W NORTH AVE",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530054423",
            "telephone_number": "262-782-4270",
            "fax_number": "262-784-9319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17000 W NORTH AVE",
            "address_2": "SUITE 200E",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530054423",
            "telephone_number": "262-782-4270",
            "fax_number": "262-784-9319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLANKENBURG",
        "first_name": "RUSSELL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-03",
        "last_updated": "2009-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "35536",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookfield, WI

Sources for this page

Verify at the official NPI Registry.