Individual provider Active NPI

Bradley Klein, APNP

  • Family Nurse Practitioner
  • Waupaca, WI
National Provider Identifier
1114579612
Registry record updated Aug 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
9425 Issued in WI
Practice address
710 Riverside Dr
Waupaca, WI 54981-1941
Phone
(715) 256-3000
Fax
(715) 256-3079
NPI assigned
Jul 15, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2019

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 9425 WI Primary

Addresses

Primary practice location

710 Riverside Dr
Waupaca, WI 54981-1941

Mailing address

122 E College Ave
Appleton, WI 54911-5794
Phone (920) 996-3264

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
I20190822001828 WI Practitioner - Nurse Practitioner 0648508093 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Thedacare, IncorporatedGroup PAC ID 1759294887, 654 clinicians

Practice addresses (Care Compare)

710 Riverside Dr
Waupaca, WI 54981-1941
Phone (715) 256-3000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
9425WIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Thedacare, Incorporated CurrentSince Aug 15, 2019 Accepting new patients

Locations

4480 W Spencer St
Appleton, WI 54914
Phone (920) 738-4800

122 E College Ave
Appleton, WI 54911
Phone (920) 996-3264

1405 Mill St
New London, WI 54961
Phone (920) 531-2000

600 N Westhaven Dr
Oshkosh, WI 54904
Phone (920) 237-5000

710 Riverside Dr
Waupaca, WI 54981
Phone (715) 256-3000

Interoperability endpoints

  • Direct secure messaging: bklein32632@direct.thedacare.org

Organizations & group practices 1

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 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": "1563148800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565827200000",
    "number": "1114579612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 E COLLEGE AVE",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549115794",
            "telephone_number": "920-996-3264",
            "fax_number": "920-830-5910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 RIVERSIDE DR",
            "city": "WAUPACA",
            "state": "WI",
            "postal_code": "549811941",
            "telephone_number": "715-256-3000",
            "fax_number": "715-256-3079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLEIN",
        "first_name": "BRADLEY",
        "credential": "APNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-15",
        "last_updated": "2019-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "9425",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waupaca, WI

Sources for this page

Verify at the official NPI Registry.