Emily J Boettcher, NP
Individual provider Active NPI Nurse Practitioner · Menominee, MI
NPI 1275368698 · NPPES record last updated Nov 25, 2024
Key facts
- NPI
- 1275368698
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 15882-33 (WI)
- Practice address
- 2408 10TH St
Menominee, MI 49858-2004 - Phone
- (906) 863-4100
- NPI assigned
- Sep 5, 2024
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Aurora Medical Group, Inc.
Practice addresses (Care Compare)
2408 10TH St
Menominee, MI 49858-2004
Phone (906) 863-4100
4061 Old Peshtigo Rd
Marinette, WI 54143-3887
Phone (715) 732-8000
Hospital & facility affiliations
- Aurora Medical Center Bay Area
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MI, WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241026000138 | MI | Practitioner - Nurse Practitioner | 0648703850 | Reassigns benefits to 1 organization |
| I20250902000585 | WI | Practitioner - Nurse Practitioner | 0648703850 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 146394 | WI | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aurora Medical Group, Inc. | Current |
Accepting new patients | |
| Aurora Medical Group, Inc. | Current |
Accepting new patients | |
| Aurora Medical Group, Inc. | Past | Accepting new patients |
Locations
2408 10th St
Menominee, MI 49858
Phone (906) 863-4100
4061 Old Peshtigo Rd
Marinette, WI 54143
Phone (715) 732-8000
1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056
Interoperability endpoints
- eboettcher152197@direct.myadvocateaurora.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 146394 | WI | |
| Nurse Practitioner | 363L00000X | 15882-33 | WI | Yes |
Addresses
Primary practice location
2408 10TH St
Menominee, MI 49858-2004
Mailing address
PO Box 735044
Chicago, IL 60673-5044
Phone (800) 326-2250
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100219613 | Medicaid | WI |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | eboettcher152197@direct.myadvocateaurora.org | Direct | |
| FHIR URL | https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/ |
Other providers in Menominee, MI
- Sherry Lynn Benson
- Trudy A Berger
- Macy Lea Berzsenyi
- Joanne Black
- Lorinda Blaisdell
- Abigayle Bradfield
- Ann Bresnahan
- Katie Broeders
- Barbara A Brown
- Michelle Brownson
All providers in Menominee, MI · Nurse Practitioner in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 25, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.