Active NPI
Thomas Stephen Brundage
- Student in an Organized Health Care Education/Training Program
- Milwaukee, WI
National Provider Identifier
1184325052
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 9200 W Wisconsin Ave
Milwaukee, WI 53226-3522 - Phone
- (414) 805-3000
- NPI assigned
- Mar 16, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
9200 W Wisconsin Ave
Milwaukee, WI 53226-3522
Mailing address
3333 Green Bay Rd
North Chicago, IL 60064-3037
Other practice location 1
3333 Green Bay Rd
North Chicago, IL 60064-3037
Phone (847) 578-3000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250825000187 | MA | Order and Referring Only - Interventional Radiology | 4789184748 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Boston Medical Center Corporation | Current | Accepting new patients |
Interoperability endpoints
- tbrundage254258@direct.bmc.masshiway.net
Organizations & group practices 1
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.
-
- General Acute Care Hospital
- Boston, MA
- NPI 1346218294
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1678924800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1711411200000",
"number": "1184325052",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3333 GREEN BAY RD",
"city": "NORTH CHICAGO",
"state": "IL",
"postal_code": "600643037"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9200 W WISCONSIN AVE",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532263522",
"telephone_number": "414-805-3000"
}
],
"practiceLocations": [
{
"address_1": "3333 Green Bay Rd",
"address_purpose": "LOCATION",
"city": "North Chicago",
"state": "IL",
"postal_code": "600643037",
"country_code": "US",
"telephone_number": "847-578-3000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BRUNDAGE",
"first_name": "THOMAS",
"middle_name": "STEPHEN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-03-16",
"last_updated": "2024-03-26",
"certification_date": "2024-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.