Individual provider Active NPI

Bryanna Bruger

  • Clinical Neuropsychologist
  • Milwaukee, WI
National Provider Identifier
1275940504
Registry record updated Feb 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
5117-057 Issued in WI
Practice address
2901 W Kinnickinnic River Pkwy Ste 403
Milwaukee, WI 53215-3660
Phone
(414) 385-8771
NPI assigned
Jul 18, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 22, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Clinical Neuropsychologist 103G00000X 5117-057 WI Primary

Addresses

Primary practice location

2901 W Kinnickinnic River Pkwy Ste 403
Milwaukee, WI 53215-3660

Mailing address

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

Other practice location 1

108 W Market St
Bloomington, IL 61701-3918
Phone (309) 827-5351

Other practice location 2

1438 S Grand Blvd
Saint Louis, MO 63104-1027
Phone (920) 517-0278

Other identifiers 1

IdentifierTypeStateIssuer
100263320MedicaidWI

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240123000300 WI Practitioner - Clinical Psychologist 4587043773 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians

Practice addresses (Care Compare)

2901 W Kinnickinnic River Pkwy
Milwaukee, WI 53215-3677
Phone (414) 649-3990

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
5117-057WIMDClinical Neuropsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Medical Group, Inc. CurrentSince Feb 5, 2024 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Feb 5, 2024 Accepting new patients
Aurora Medical Group, Inc. PastSince Feb 25, 2024 Accepting new patients

Locations

2901 W Kinnickinnic River Pkwy
Milwaukee, WI 53215
Phone (414) 385-3084

2901 W Kinnickinnic River Pkwy
Ste 403
Milwaukee, WI 53215
Phone (414) 385-1874

2901 W Kinnickinnic River Pkwy
Ste 204
Milwaukee, WI 53215
Phone (414) 382-8960

1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1405641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708560000000",
    "number": "1275940504",
    "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": "2901 W KINNICKINNIC RIVER PKWY STE 403",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532153660",
            "telephone_number": "414-385-8771"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "108 W Market St",
            "address_purpose": "LOCATION",
            "city": "Bloomington",
            "state": "IL",
            "postal_code": "617013918",
            "country_code": "US",
            "telephone_number": "309-827-5351",
            "fax_number": "309-829-6808",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1438 S Grand Blvd",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631041027",
            "country_code": "US",
            "telephone_number": "920-517-0278",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRUGER",
        "first_name": "BRYANNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-07-18",
        "last_updated": "2024-02-22",
        "certification_date": "2024-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "WI",
            "license": "5117-057",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100263320",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.