Individual provider Active NPI

Kathy Susan Hernandez, M.D.

  • Family Medicine Physician
  • Milwaukee, WI
National Provider Identifier
1164427654
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
32458 Issued in WI
Practice address
1032 S Cesar E Chavez Dr
Milwaukee, WI 53204-2203
Phone
(414) 672-1353
Fax
(414) 672-4265
NPI assigned
Jun 20, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 32458 WI Primary

Addresses

Primary practice location

1032 S Cesar E Chavez Dr
Milwaukee, WI 53204-2203

Mailing address

1032 S Cesar E Chavez Dr
Milwaukee, WI 53204-2203
Phone (414) 672-1353

Other identifiers 4

IdentifierTypeStateIssuer
31735400MedicaidWI
810127286OtherWIPRIVATEHEALTHCARE SYSTEM
4654337OtherWIAETNA
3596782OtherWICIGNA

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101109001328 WI Practitioner - Family Practice 9638364284 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of California, San Diego School of Medicine, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1032 S Cesar E Chavez Dr
Milwaukee, WI 53204-2203
Phone (414) 672-1353

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
32458WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
16TH Street Community Health Center Inc. Family Medicine Current Accepting new patients
16TH Street Community Health Center Inc. Family Medicine CurrentSince Sep 1, 1999 Accepting new patients
Sixteenth Street Community Health Centers, Inc. Family Medicine CurrentSince Sep 1, 1999 Accepting new patients

Locations

4570 S 27th St
Milwaukee, WI 53221
Phone (414) 325-8720

1032 S Cesar E Chavez Dr
Milwaukee, WI 53204

2906 S 20th St
Milwaukee, WI 53215
Phone (414) 385-8800

1635 W National Ave
Milwaukee, WI 53204
Phone (262) 408-5094

309 E North St
Waukesha, WI 53188
Phone (262) 408-2530

Interoperability endpoints

  • Direct secure messaging: khernandez354283@direct.ochin.org

Organizations & group practices 3

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": "1119225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1164427654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1032 S CESAR E CHAVEZ DR",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532042203",
            "telephone_number": "414-672-1353",
            "fax_number": "414-672-4265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1032 S CESAR E CHAVEZ DR",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532042203",
            "telephone_number": "414-672-1353",
            "fax_number": "414-672-4265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERNANDEZ",
        "first_name": "KATHY",
        "middle_name": "SUSAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-20",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "32458",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31735400",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIVATEHEALTHCARE SYSTEM",
            "identifier": "810127286",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4654337",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "3596782",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.