Individual provider Active NPI

Katherine Bougie

  • Physician Assistant
  • Milwaukee, WI
National Provider Identifier
1114615895
Registry record updated May 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
2301 N Lake Dr
Milwaukee, WI 53211-4508
Phone
(414) 585-1000
NPI assigned
May 1, 2023
Last updated
May 1, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 1, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU Primary

Addresses

Primary practice location

2301 N Lake Dr
Milwaukee, WI 53211-4508

Mailing address

W142N10576 Magnolia Dr
Germantown, WI 53022-6217
Phone (414) 507-6199

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
I20230718003316 WI Practitioner - Physician Assistant 2668832957 Reassigns benefits to 2 organizations

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)

13950 W Capitol Dr
Brookfield, WI 53005-2441
Phone (414) 302-5400

201 N Mayfair Rd
Wauwatosa, WI 53226-4216

2301 N Lake Dr
Milwaukee, WI 53211-4508

2311 N Prospect Ave
Milwaukee, WI 53211-4445
Phone (414) 319-3000

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

2350 N Lake Dr
Milwaukee, WI 53211-4528

801 S 70TH St
West Allis, WI 53214-3147
Phone (414) 773-6600

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Columbia St. Mary's Hospital Milwaukee Inc CurrentSince Aug 2, 2023 Accepting new patients
Ascension Medical Group-Southeast Wisconsin Inc Physician Assistant CurrentSince Jun 12, 2023 Accepting new patients
Columbia St. Mary's Hospital Milwaukee, Inc Past Accepting new patients

Locations

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

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

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

201 N Mayfair Rd
Wauwatosa, WI 53226
Phone (414) 259-7200

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

Organizations & group practices 4

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 3

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": "1682899200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682899200000",
    "number": "1114615895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W142N10576 MAGNOLIA DR",
            "city": "GERMANTOWN",
            "state": "WI",
            "postal_code": "530226217",
            "telephone_number": "414-507-6199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 N LAKE DR",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532114508",
            "telephone_number": "414-585-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUGIE",
        "first_name": "KATHERINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-01",
        "last_updated": "2023-05-01",
        "certification_date": "2023-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.