Individual provider Active NPI

Elizabeth Hagen, MD

  • Pediatrics Physician
  • Cedarburg, WI
National Provider Identifier
1164440574
Registry record updated Mar 26, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
35576 Issued in WI
Practice address
N143W6515 Pioneer Rd
Cedarburg, WI 53012-2705
Phone
(262) 377-6933
NPI assigned
Jul 17, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 35576 WI Primary

Addresses

Primary practice location

N143W6515 Pioneer Rd
Cedarburg, WI 53012-2705

Mailing address

4425 N Port Washington Rd
Attn: Csmcp Clinic Credentialing
Glendale, WI 53212-1082
Phone (262) 377-6933

Other identifiers 1

IdentifierTypeStateIssuer
32223300MedicaidWI

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
I20100805000835 WI Practitioner - Pediatric Medicine 0345373742 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35576WIMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. CurrentSince Sep 23, 2022 Accepting new patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. CurrentSince Sep 23, 2022 Accepting new patients
DRS. Massaro & Kalenak S C Current Accepting new patients
The Medical College of Wisconsin, Inc. Current Accepting new patients

Locations

N69W5269 Columbia Rd
Cedarburg, WI 53012
Phone (262) 474-8600

N143W6515 Pioneer Rd
Cedarburg, WI 53012
Phone (262) 377-2495

W168N11237 Western Ave
Germantown, WI 53022
Phone (262) 253-5060

N74W12501 Leatherwood Ct
Menomonee Falls, WI 53051
Phone (414) 454-4744

W180N8000 Town Hall Rd
Menomonee Falls, WI 53051
Phone (262) 255-2500

1155 N Mayfair Rd
Wauwatosa, WI 53226
Phone (414) 955-5990

Interoperability endpoints

  • Direct secure messaging: ehagen147006@direct.froedtert.com

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": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395792000000",
    "number": "1164440574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4425 N PORT WASHINGTON RD",
            "address_2": "ATTN: CSMCP CLINIC CREDENTIALING",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532121082",
            "telephone_number": "262-377-6933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N143W6515 PIONEER RD",
            "city": "CEDARBURG",
            "state": "WI",
            "postal_code": "530122705",
            "telephone_number": "262-377-6933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAGEN",
        "first_name": "ELIZABETH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-17",
        "last_updated": "2014-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WI",
            "license": "35576",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32223300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cedarburg, WI

Sources for this page

Verify at the official NPI Registry.