Individual provider Active NPI

Kelly Ann Cullen, D.O.

  • Emergency Medicine Physician
  • Milwaukee, WI
National Provider Identifier
1295792711
Registry record updated Nov 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
036101865 Issued in IL
Practice address
111 E Wisconsin Ave
Suite 2000
Milwaukee, WI 53202-4815
Phone
(414) 290-6720
Fax
(414) 290-6755
NPI assigned
Apr 27, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 44859-021 WI
Emergency Medicine Physician 207P00000X 036101865 IL Primary

Addresses

Primary practice location

111 E Wisconsin Ave
Suite 2000
Milwaukee, WI 53202-4815

Mailing address

111 E Wisconsin Ave
Suite 2000
Milwaukee, WI 53202-4815
Phone (414) 290-6720

Other identifiers 3

IdentifierTypeStateIssuer
036101865MedicaidIL
43509700MedicaidWI
930093591OtherILMEDICARE RAILROAD

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address kcullen237943@direct.myadvocateaurora.org
FHIR URL https://epicfhir.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, IL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20031205000458 WI Practitioner - Emergency Medicine 2163327735 Reassigns benefits to 1 organization
I20061120000171 IL Practitioner - Emergency Medicine 2163327735 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cepamerica Illinois LLPGroup PAC ID 3274793633, 492 clinicians

Practice addresses (Care Compare)

801 S Milwaukee Ave
Libertyville, IL 60048-3204
Phone (847) 990-5300

Hospital & facility affiliations

  • Advocate Condell Medical Center Hospital, Libertyville, IL, CCN 140202

Merit-based Incentive Payment System (MIPS)

Final score
93.41 of 100Reported as group
Quality
86.81
Improvement activities
40
Cost
77.34

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036101865ILMDEmergency Medicine Physician
44859-021WIMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cepamerica Illinois LLP Emergency Medicine Current Accepting new patients
Vituity-Wisconsin Em SC Emergency Medicine CurrentSince Aug 15, 2023 Accepting new patients
Cepamerica Illinois LLP Emergency Medicine CurrentSince Dec 22, 2022 Accepting new patients
Cepamerica Illinois LLP Emergency Medicine CurrentSince Dec 22, 2022 Accepting new patients
Vituity-Wisconsin Em SC Emergency Medicine CurrentSince Aug 15, 2023 Accepting new patients
Froedtert South, Inc. Past Accepting new patients
Froedtert South, Inc. Past Accepting new patients
Ihc-St. Nicholas Emergency Physicians, LLC Emergency Medicine Past Accepting new patients
United Occupational Medicine and Walk in Services, LLC Emergency Medicine Past Accepting new patients

Locations

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

1425 N Randall Rd
Elgin, IL 60123
Phone (224) 783-5437

355 Ridge Ave
Evanston, IL 60202
Phone (847) 316-2329

801 S Milwaukee Ave
Libertyville, IL 60048
Phone (847) 362-2900

9555 76th St
Pleasant Prairie, WI 53158
Phone (262) 577-8000

Interoperability endpoints

  • Direct secure messaging: kcullen237943@direct.myadvocateaurora.org

Organizations & group practices 9

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": "1146096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668470400000",
    "number": "1295792711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 E WISCONSIN AVE",
            "address_2": "SUITE 2000",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532024815",
            "telephone_number": "414-290-6720",
            "fax_number": "414-290-6755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 E WISCONSIN AVE",
            "address_2": "SUITE 2000",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532024815",
            "telephone_number": "414-290-6720",
            "fax_number": "414-290-6755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CULLEN",
        "first_name": "KELLY ANN",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-27",
        "last_updated": "2022-11-15",
        "certification_date": "2022-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WI",
            "license": "44859-021",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036101865",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036101865",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43509700",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "930093591",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kcullen237943@direct.myadvocateaurora.org",
            "affiliation": "N",
            "address_1": "111 E Wisconsin Ave",
            "address_2": "Suite 2000",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532024815",
            "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": "111 E Wisconsin Ave",
            "address_2": "Suite 2000",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532024815",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.