Individual provider Active NPI

Candice Smith

  • Nurse Practitioner
  • Milwaukee, WI
National Provider Identifier
1306225008
Registry record updated Jun 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
6378-33 Issued in WI
Practice address
9000 W Wisconsin Ave
Milwaukee, WI 53226-4874
Phone
(414) 266-2420
Fax
(414) 266-6837
NPI assigned
May 27, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 6378-33 WI Primary

Addresses

Primary practice location

9000 W Wisconsin Ave
Milwaukee, WI 53226-4874

Mailing address

9000 W Wisconsin Ave
Milwaukee, WI 53226-4874
Phone (414) 266-2420

Other identifiers 1

IdentifierTypeStateIssuer
1306225008MedicaidWI

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150831001944 WI Practitioner - Nurse Practitioner 9830405224 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of South Alabama College of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Childrens Specialty Group IncGroup PAC ID 2567813447, 206 clinicians

Practice addresses (Care Compare)

9000 W Wisconsin Ave
Milwaukee, WI 53226-4874
Phone (414) 266-2000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
6378-33WIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Children'S Specialty Group, Inc. CurrentSince Sep 11, 2024 Accepting new patients
The Medical College of Wisconsin, Inc. CurrentSince Sep 15, 2015 Accepting new patients

Locations

8701 Watertown Plank Rd
Wauwatosa, WI 53226
Phone (414) 456-4100

9000 W Wisconsin Ave
Wauwatosa, WI 53226
Phone (414) 266-2625

Interoperability endpoints

  • Direct secure messaging: csmith16313@direct.chw.org

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": "1432684800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622851200000",
    "number": "1306225008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9000 W WISCONSIN AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532264874",
            "telephone_number": "414-266-2420",
            "fax_number": "414-266-6837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9000 W WISCONSIN AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532264874",
            "telephone_number": "414-266-2420",
            "fax_number": "414-266-6837"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "CANDICE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-27",
        "last_updated": "2021-06-05",
        "certification_date": "2021-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "6378-33",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1306225008",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.