Individual provider Active NPI

Madeline Tennant

  • Physician Assistant
  • Milwaukee, WI
National Provider Identifier
1255823233
Registry record updated Dec 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
100962 Issued in WI
Practice address
2801 W KK River Pkwy Ste 370
Milwaukee, WI 53215-3678
Phone
(414) 649-7900
NPI assigned
Jun 5, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085-006588 IL
Physician Assistant 363A00000X 100962 WI Primary

Addresses

Primary practice location

2801 W KK River Pkwy Ste 370
Milwaukee, WI 53215-3678

Mailing address

PO Box 735044
Chicago, IL 60673-5044
Phone (800) 326-2250

Other practice location 1

9000 Waukegan Rd Ste 200
Morton Grove, IL 60053-2127
Phone (847) 375-3000

Other identifiers 1

IdentifierTypeStateIssuer
100253415MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address tmadeline240154@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

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
I20231103002622 WI Practitioner - Physician Assistant 3971851411 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aurora Advanced Healthcare, Inc.Group PAC ID 3375625833, 1,107 clinicians

Practice addresses (Care Compare)

1032 E Sumner St
Hartford, WI 53027-1608
Phone (262) 673-2300

12203 N Corporate Pkwy
Mequon, WI 53092-3388
Phone (262) 387-8200

1640 E Sumner St
Hartford, WI 53027-2684
Phone (262) 670-4000

3003 W Good Hope Rd
Milwaukee, WI 53209-2042
Phone (414) 352-3100

945 N 12TH St
Milwaukee, WI 53233-1305
Phone (414) 219-2000

W180N11070 River LN
Germantown, WI 53022-3109
Phone (262) 532-9700

Hospital & facility affiliations

  • Aurora Medical Ctr Washington County Hospital, Hartford, WI, CCN 520038
  • Aurora Medical Center Hospital, Grafton, WI, CCN 520207

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
085-006588ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Advanced Healthcare Inc CurrentSince Sep 23, 2023 Accepting new patients
Aurora Advanced Healthcare, Inc. CurrentSince Sep 23, 2023 Accepting new patients

Locations

3003 W Good Hope Rd
Glendale, WI 53209
Phone (414) 352-3100

975 Port Washington Rd
Ste 110
Grafton, WI 53024
Phone (262) 329-1000

1640 E Sumner St
Hartford, WI 53027
Phone (262) 670-4000

12203 N Corporate Pkwy
Mequon, WI 53092
Phone (262) 387-8200

2801 W Kinnickinnic River Pkwy
Ste 370
Milwaukee, WI 53215
Phone (414) 649-1280

Organizations & group practices 2

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1528156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703030400000",
    "number": "1255823233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 735044",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606735044",
            "telephone_number": "800-326-2250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 W KK RIVER PKWY STE 370",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532153678",
            "telephone_number": "414-649-7900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9000 Waukegan Rd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Morton Grove",
            "state": "IL",
            "postal_code": "600532127",
            "country_code": "US",
            "telephone_number": "847-375-3000",
            "fax_number": "847-929-1154",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TENNANT",
        "first_name": "MADELINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-05",
        "last_updated": "2023-12-20",
        "certification_date": "2023-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085-006588",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "100962",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100253415",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tmadeline240154@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2801 W Kk River Pkwy Ste 370",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532153678",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "2801 W Kk River Pkwy Ste 370",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532153678",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.