Individual provider Active NPI

Candace S Morton, APNP

  • Pediatric Nurse Practitioner
  • Milwaukee, WI
National Provider Identifier
1336191840
Registry record updated Feb 7, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
2053 Issued in WI
Practice address
9000 W Wisconsin Ave
Pediatric Cardiology
Milwaukee, WI 53226-4874
Phone
(414) 266-2380
Fax
(414) 266-7251
NPI assigned
May 16, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 2053 WI Primary

Addresses

Primary practice location

9000 W Wisconsin Ave
Pediatric Cardiology
Milwaukee, WI 53226-4874

Mailing address

9000 W Wisconsin Ave
Pediatric Cardiology
Milwaukee, WI 53226-4874
Phone (414) 266-2380

Other identifiers 2

IdentifierTypeStateIssuer
000017792POtherHUMANA
1336191840MedicaidWI

Other names 1

  • Ms. Candace S Buckles Former name

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
I20040806001247 WI Practitioner - Nurse Practitioner 6204808660 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
The Medical College of Wisconsin, Inc. CurrentSince Jun 21, 2004 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

Organizations & group practices 1

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": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1360195200000",
    "number": "1336191840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9000 W WISCONSIN AVE",
            "address_2": "PEDIATRIC CARDIOLOGY",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532264874",
            "telephone_number": "414-266-2380",
            "fax_number": "414-266-7251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9000 W WISCONSIN AVE",
            "address_2": "PEDIATRIC CARDIOLOGY",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532264874",
            "telephone_number": "414-266-2380",
            "fax_number": "414-266-7251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORTON",
        "first_name": "CANDACE",
        "middle_name": "S",
        "name_prefix": "Ms.",
        "credential": "APNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-16",
        "last_updated": "2013-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "WI",
            "license": "2053",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "000017792P",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1336191840",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CANDACE",
            "last_name": "BUCKLES",
            "middle_name": "S",
            "prefix": "MS.",
            "credential": "APNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.