Individual provider Active NPI

Kathleen Mary Glaser

  • Gerontology Nurse Practitioner
  • Delafield, WI
National Provider Identifier
1225170392
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
79585-030 Issued in WI
Practice address
W328S1001 Timberline Cir
Delafield, WI 53018-3349
Phone
(262) 646-3849
Fax
(262) 646-3849
NPI assigned
Feb 13, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 79585-030 WI Primary

Addresses

Primary practice location

W328S1001 Timberline Cir
Delafield, WI 53018-3349

Mailing address

W180N8085 Town Hall Rd
Menomonee Falls, WI 53051-3518
Phone (262) 257-3340

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
I20040526001391 WI Practitioner - Nurse Practitioner 3274514179 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
35.83 of 100Reported as group
Quality
9.6
Promoting interoperability
0
Improvement activities
0
Cost
76.51

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1030WIMDBehavioral Analyst
79585-030WIMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Cary J Kohlenberg MD SC CurrentSince Jan 20, 2010 Accepting new patients
Wisconsin Heart Group Past Accepting new patients
Wisconsin Heart Group Associates LLC Past Accepting new patients
The Medical College of Wisconsin, Inc. Past Accepting new patients

Locations

845 Highway NN E
Mukwonago, WI 53149
Phone (262) 363-6830

2717 N Grandview Blvd
Ste 102
Waukesha, WI 53188
Phone (262) 513-0700

2717 N Grandview Blvd
Ste 202
Waukesha, WI 53188
Phone (262) 513-0700

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, 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": "1171324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1225170392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W180N8085 TOWN HALL RD",
            "city": "MENOMONEE FALLS",
            "state": "WI",
            "postal_code": "530513518",
            "telephone_number": "262-257-3340",
            "fax_number": "262-257-2571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W328S1001 TIMBERLINE CIR",
            "city": "DELAFIELD",
            "state": "WI",
            "postal_code": "530183349",
            "telephone_number": "262-646-3849",
            "fax_number": "262-646-3849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLASER",
        "first_name": "KATHLEEN",
        "middle_name": "MARY",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "WI",
            "license": "79585-030",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Delafield, WI

Sources for this page

Verify at the official NPI Registry.