Individual provider Active NPI

Cienna Michelle Blum

  • Speech-Language Pathologist
  • Greenfield, WI
National Provider Identifier
1285475145
Registry record updated Jul 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
6609 Issued in WI
Practice address
9000 W Sura LN
Greenfield, WI 53228-3477
Phone
(414) 246-6800
NPI assigned
Jun 4, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 6609 WI Primary

Addresses

Primary practice location

9000 W Sura LN
Greenfield, WI 53228-3477

Mailing address

11621 W Brown Deer Rd Apt 10
Milwaukee, WI 53224-1440
Phone (414) 699-4624

Other identifiers 1

IdentifierTypeStateIssuer
100279349MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address cblum399397@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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240626000809 WI Practitioner - Qualified Speech Language Pathologist 1951845403 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6609WIMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Medical Group, Inc. CurrentSince Jun 10, 2024 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Jun 10, 2024 Accepting new patients

Locations

9000 W Sura Ln
Milwaukee, WI 53228
Phone (414) 246-6500

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

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.

NPI Registry JSON

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

{
    "created_epoch": "1717459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721174400000",
    "number": "1285475145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11621 W BROWN DEER RD APT 10",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532241440",
            "telephone_number": "414-699-4624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9000 W SURA LN",
            "city": "GREENFIELD",
            "state": "WI",
            "postal_code": "532283477",
            "telephone_number": "414-246-6800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLUM",
        "first_name": "CIENNA",
        "middle_name": "MICHELLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-04",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WI",
            "license": "6609",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100279349",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cblum399397@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "9000 W Sura Ln",
            "city": "Greenfield",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532283477",
            "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": "9000 W Sura Ln",
            "city": "Greenfield",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532283477",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Greenfield, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.