Individual provider Active NPI

Annie Carrell

  • Psychiatric/Mental Health Nurse Practitioner
  • Milwaukee, WI
National Provider Identifier
1184076713
Registry record updated Jul 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
7040-33 Issued in WI
Practice address
210 W Capitol Dr
Milwaukee, WI 53212-1123
Phone
(414) 727-6320
Fax
(414) 727-6329
NPI assigned
Jul 7, 2016
Last updated
Jul 7, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 7040-33 WI Primary

Addresses

Primary practice location

210 W Capitol Dr
Milwaukee, WI 53212-1123

Mailing address

711 West Capitol Drive
Milwaukee, WI 53206
UM
Phone (414) 727-6320

Other identifiers 1

IdentifierTypeStateIssuer
7040-33OtherWIWI LICENSE

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
I20171213002572 WI Practitioner - Nurse Practitioner 9739447103 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

220 W Capitol Dr
Milwaukee, WI 53212-1185
Phone (414) 727-6320

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
7040-33WIMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Outreach Community Health Centers, Inc. CurrentSince Oct 4, 2017 Accepting new patients
Outreach Community Health Centers, Inc. CurrentSince Oct 4, 2017 Accepting new patients
Outreach Community Health Centers, Inc Current Accepting new patients

Locations

210 W Capitol Dr
Glendale, WI 53212

220 W Capitol Dr
Glendale, WI 53212
Phone (414) 374-2400

711 W Capitol Dr
Milwaukee, WI 53206
Phone (414) 374-2400

Interoperability endpoints

  • Direct secure messaging: acarrell185806@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, 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": "1467849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467849600000",
    "number": "1184076713",
    "addresses": [
        {
            "country_code": "UM",
            "country_name": "United States Minor Outlying Islands",
            "address_purpose": "MAILING",
            "address_type": "FGN",
            "address_1": "711 WEST CAPITOL DRIVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "53206",
            "telephone_number": "414-727-6320",
            "fax_number": "414-727-6329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 W CAPITOL DR",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532121123",
            "telephone_number": "414-727-6320",
            "fax_number": "414-727-6329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARRELL",
        "first_name": "ANNIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-07",
        "last_updated": "2016-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WI",
            "license": "7040-33",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WI LICENSE",
            "identifier": "7040-33",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.