Kirstin M Certalic, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

40646 Issued in WI

Practice address

2315 E Moreland Blvd
Westbrook Walk-in Clinic
Waukesha, WI 53186-2939

Phone

(262) 532-5800

Fax

(262) 532-5760

NPI assigned

Aug 7, 2006

Last updated

Mar 7, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Kirstin Maureen Crowe Former name

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Dignity Community Care

  dba Chandler Regional Medical Center

  • General Acute Care Hospital
  • Chandler, AZ
  • NPI 1700910189
  Medicare reassignment NPD
• Aurora Medical Group, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Union Grove, WI
  • NPI 1245440601
  NPD (past)
• Aurora Medical Group, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Oshkosh, WI
  • NPI 1326858044
  NPD (past)
• Chandler Regional Medical Center

  dba CRMC Trauma Services

  • Emergency Care Clinic/Center
  • Chandler, AZ
  • NPI 1871910968
  NPD (past)

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

{
    "created_epoch": "1154908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1275542326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2315 E MORELAND BLVD",
            "address_2": "WESTBROOK WALK-IN CLINIC",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531862939",
            "telephone_number": "262-532-5800",
            "fax_number": "262-532-5760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2315 E MORELAND BLVD",
            "address_2": "WESTBROOK WALK-IN CLINIC",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531862939",
            "telephone_number": "262-532-5800",
            "fax_number": "262-532-5760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CERTALIC",
        "first_name": "KIRSTIN",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-07",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "40646",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30091900",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1275542326",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIRSTIN",
            "last_name": "CROWE",
            "middle_name": "MAUREEN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Mia Cederholm
• Annette Centeno
• Kimberly Sue Centgraf, DVM
• Jennifer Lynn Cera, BSW
• Anna E Cerny, RDH
• Victoria Champeau, LPN
• Kevin Chiayu Chan, D.O.
• Changing Hearts Community Care LLC
• Jenna Nicole Chaplock, BS
• Brian A. Chapman, M.D.

• Family Medicine Physician in Waukesha, WI
• Providers in Waukesha, WI by specialty
• Family Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.

Verify at the official NPI Registry.