NPIMap

Individual provider Active NPI

Agnieszka Dendura

  • Nurse Practitioner
  • Tomah, WI
National Provider Identifier
1164057717
Registry record updated Jan 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
9811-33 Issued in WI
Practice address
501 Gopher Dr
Tomah, WI 54660-4513
Phone
(608) 371-2181
NPI assigned
Mar 4, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 9811-33 WI Primary

Addresses

Primary practice location

501 Gopher Dr
Tomah, WI 54660-4513

Mailing address

501 Gopher Dr
Tomah, WI 54660-4513

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address adenura19912@direct.monroeclinic.org Direct Tomah Memorial Hospital Inc

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
I20200327000447 WI Practitioner - Nurse Practitioner 7911336995 Reassigns benefits to 2 organizations

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
Mile Bluff Medical Center IncGroup PAC ID 8527971399, 87 clinicians

Practice addresses (Care Compare)

1040 Division St
Mauston, WI 53948-1931
Phone (608) 847-1852

Hospital & facility affiliations

  • Mile Bluff Medical Center Hospital, Mauston, WI, CCN 520109

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
9811-33WIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mile Bluff Medical Center Inc Current Accepting new patients
Tomah Memorial Hospital Inc CurrentSince May 1, 2020 Accepting new patients
Tomah Memorial Hospital Inc CurrentSince May 1, 2020 Accepting new patients
Mile Bluff Medical Center Inc CurrentSince Jun 1, 2021 Accepting new patients
Mile Bluff Medical Center Inc CurrentSince Jun 1, 2021 Accepting new patients
Mile Bluff Medical Center Inc Past Accepting new patients

Locations

1515 Academy St
Elroy, WI 53929
Phone (608) 462-8414

1040 Division St
Mauston, WI 53948
Phone (608) 847-5000

1050 Division St
Mauston, WI 53948
Phone (608) 847-6161

1408 Wheelihan Ave
Necedah, WI 54646
Phone (608) 565-2000

901 W Bridge St
New Lisbon, WI 53950
Phone (608) 562-3111

501 Gopher Dr
Tomah, WI 54660
Phone (608) 371-2181

28 Commerce St
Wisconsin Dells, WI 53965
Phone (608) 254-5888

Interoperability endpoints

  • Direct secure messaging: agnieszka.dendura@direct.milebluff.com
  • Direct secure messaging: adendura636313@direct.gundersenhealth.org

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 2

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": "1583280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610582400000",
    "number": "1164057717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 GOPHER DR",
            "city": "TOMAH",
            "state": "WI",
            "postal_code": "546604513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 GOPHER DR",
            "city": "TOMAH",
            "state": "WI",
            "postal_code": "546604513",
            "telephone_number": "608-371-2181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DENDURA",
        "first_name": "AGNIESZKA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-04",
        "last_updated": "2021-01-14",
        "certification_date": "2021-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "9811-33",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "adenura19912@direct.monroeclinic.org",
            "affiliation": "Y",
            "affiliationName": "Tomah Memorial Hospital Inc",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "adenura19912@direct.monroeclinic.org",
            "address_1": "501 Gopher Dr",
            "city": "Tomah",
            "state": "WI",
            "country_code": "US",
            "postal_code": "546604513",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Tomah, WI

Sources for this page

Verify at the official NPI Registry.