NPIMap

Individual provider Active NPI

Vicki Lynn Waedekin, P.A.

  • Physician Assistant
  • Wales, WI
National Provider Identifier
1164408100
Registry record updated Dec 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
923-023 Issued in WI
Practice address
144 E Summit Ave
Wales, WI 53183-9546
Phone
(262) 968-6161
NPI assigned
Dec 21, 2005
Last updated
Dec 6, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2021

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 923-023 WI Primary

Addresses

Primary practice location

144 E Summit Ave
Wales, WI 53183-9546

Mailing address

144 E Summit Ave
Wales, WI 53183-9546
Phone (262) 968-6161

Other identifiers 1

IdentifierTypeStateIssuer
42981900MedicaidWI

Other names 1

  • Vicki L Beck Former name

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address vbeck84872@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
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
923-023WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Medical Group, Inc. Past Accepting new patients
Astia Health Clinical Services, SC Past Accepting new patients
Aurora Quick Care, LLC Past Accepting new patients
Prohealth Medical Group Inc Past Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/
  • Direct secure messaging: vbeck84872@direct.myadvocateaurora.org

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1135123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638748800000",
    "number": "1164408100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "144 E SUMMIT AVE",
            "city": "WALES",
            "state": "WI",
            "postal_code": "531839546",
            "telephone_number": "262-968-6161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "144 E SUMMIT AVE",
            "city": "WALES",
            "state": "WI",
            "postal_code": "531839546",
            "telephone_number": "262-968-6161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAEDEKIN",
        "first_name": "VICKI",
        "middle_name": "LYNN",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-21",
        "last_updated": "2021-12-06",
        "certification_date": "2021-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "923-023",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42981900",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "vbeck84872@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "144 E Summit Ave",
            "city": "Wales",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531839546",
            "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": "144 E Summit Ave",
            "city": "Wales",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531839546",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "VICKI",
            "last_name": "BECK",
            "middle_name": "L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Wales, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.