Russell Blankenburg, MD

Key facts

NPI

1104893577

Entity type

Individual (NPI type 1)

Primary specialty

Internal Medicine Physician 207R00000X

License

35536 (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

Sex

Male

Sole proprietor

No

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.

• Ascension Medical Group-Southeast Wisconsin Inc Internal Medicine Physician · Glendale, WI · NPI 1609881077
  Medicare reassignment Care Compare group NPD INTERNAL MEDICINE · WI
• Ascension All Saints Hospital, Inc Rehabilitation Hospital Unit · Racine, WI · NPI 1417966540
  NPD (past)

Hospital & facility affiliations 7

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

• Ascension SE Wisconsin Hospital, Inc General Acute Care Hospital · Milwaukee, WI · NPI 1427007384
  Care Compare affiliation Hospital
• Ascension SE Wisconsin Hospital, Inc Rehabilitation Hospital Unit · Brookfield, WI · NPI 1861417362
  Care Compare affiliation Hospital
• Ascension St Francis Hospital, Inc General Acute Care Hospital · Milwaukee, WI · NPI 1225087190
  Care Compare affiliation Hospital
• Columbia St. Mary'S Hospital Milwaukee, Inc. General Acute Care Hospital · Milwaukee, WI · NPI 1871656082
  Care Compare affiliation Hospital
• Froedtert Memorial Lutheran Hospital, Inc. General Acute Care Hospital · Milwaukee, WI · NPI 1255334173
  Care Compare affiliation Hospital
• Prohealth Waukesha Memorial Hospital, Inc. General Acute Care Hospital · Waukesha, WI · NPI 1629056890
  Care Compare affiliation Hospital
• Wheaton Franciscan Home Health & Hospice, LLC Home Health Agency · Milwaukee, WI · NPI 1003820861
  Care Compare affiliation Home health agency

Medicare Care Compare profile

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

Ascension Medical Group-Southeast Wisconsin Inc (551 clinicians)

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ascension at Home Home health agency · Milwaukee, WI · CCN 527187
• Ascension SE Wisconsin Hospital Hospital · Milwaukee, WI · CCN 520136
• Waukesha Memorial Hospital Hospital · Waukesha, WI · CCN 520008
• Ascension Columbia St Marys Hospital Milwaukee Hospital · Milwaukee, WI · CCN 520051
• Ascension St Francis Hospital Hospital · Milwaukee, WI · CCN 520078
• Froedtert Memorial Lutheran Hospital Hospital · Milwaukee, WI · CCN 520177

Procedures performed for Medicare patients

Medicare participation

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Medicine

Practice roles

Locations

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 7, 2009.

{
    "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32210000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookfield, WI

• Stuart E Blacher, MD
• Aubrey Blahnik, MS, CCC-SLP
• Ryan R. Blair
• Christopher Allen Blake, DDS
• Sara Blandino, LMT
• Bryanne Lee Blanton, BCBA, LBA, MS
• Gregory Michael Blau, D.C.
• Dean Thomas Blazek, D.C.
• Madeline Bliske, PHD
• Blooming Buds Medicine

All providers in Brookfield, WI · Internal Medicine Physician in Wisconsin