Individual provider Active NPI

Kirby Kristine Hancock, PA-C

  • Physician Assistant
  • Milwaukee, WI
National Provider Identifier
1124513528
Registry record updated Apr 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
4416-23 Issued in WI
Practice address
2901 W Kinnickinnic River Pkwy
Milwaukee, WI 53215-3677
Phone
(414) 646-8900
Fax
(414) 646-8995
NPI assigned
Jun 27, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2025

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 4416-23 WI Primary

Addresses

Primary practice location

2901 W Kinnickinnic River Pkwy
Milwaukee, WI 53215-3677

Mailing address

PO Box 735044
Chicago, IL 60673-5044
Phone (800) 326-2250

Other practice location 1

2350 N Lake Dr Ste 302
Milwaukee, WI 53211-4528
Phone (414) 298-7104

Other identifiers 1

IdentifierTypeStateIssuer
100079338MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address khancock421519@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

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
I20180808003090 WI Practitioner - Physician Assistant 2860740701 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians

Practice addresses (Care Compare)

2200 E Kenwood Blvd
Milwaukee, WI 53211-3361
Phone (414) 229-4627

2900 W Oklahoma Ave
Milwaukee, WI 53215-4330
Phone (414) 646-5410

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4416-23WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Medical Group, Inc. CurrentSince Feb 24, 2025 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Feb 24, 2025 Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients

Locations

2200 E Kenwood Blvd
Milwaukee, WI 53211
Phone (414) 229-4627

2801 W Kinnickinnic River Pkwy
Ste 436
Milwaukee, WI 53215
Phone (414) 649-3577

2901 W Kinnickinnic River Pkwy
Milwaukee, WI 53215
Phone (414) 385-3084

Interoperability endpoints

  • Direct secure messaging: khancock421519@direct.myadvocateaurora.org

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1530057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744675200000",
    "number": "1124513528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 735044",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606735044",
            "telephone_number": "800-326-2250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2901 W KINNICKINNIC RIVER PKWY",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532153677",
            "telephone_number": "414-646-8900",
            "fax_number": "414-646-8995"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2350 N Lake Dr Ste 302",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532114528",
            "country_code": "US",
            "telephone_number": "414-298-7104",
            "fax_number": "414-298-7117",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HANCOCK",
        "first_name": "KIRBY",
        "middle_name": "KRISTINE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-27",
        "last_updated": "2025-04-15",
        "certification_date": "2025-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "4416-23",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100079338",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "khancock421519@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2901 W Kinnickinnic River Pkwy",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532153677",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "2901 W Kinnickinnic River Pkwy",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532153677",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.