Individual provider Active NPI

Cathy M Sukowaty, APNP, MSN, BSN

  • Nurse Practitioner
  • Manitowoc, WI
National Provider Identifier
1336209402
Registry record updated Apr 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
1120 Issued in WI
Practice address
1111 Bayshore Dr
Manitowoc, WI 54220-5548
Phone
(920) 682-6376
Fax
(920) 652-0115
NPI assigned
Dec 11, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 10, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 1120-033 WI
Nurse Practitioner 363L00000X 1120 WI Primary

Addresses

Primary practice location

1111 Bayshore Dr
Manitowoc, WI 54220-5548

Mailing address

1035 Kepler Dr
Green Bay, WI 54311-8320

Other identifiers 1

IdentifierTypeStateIssuer
43861300MedicaidWI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address csukowaty54676@direct.myadvocateaurora.org

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
I20050103000532 WI Practitioner - Nurse Practitioner 9830157163 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
86.21 of 100Reported as group
Quality
78.54
Promoting interoperability
100
Improvement activities
40
Cost
75.5

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Bachelor on Science - Nursing, Master of Science - Nursing, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1120-033WIMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Baycare Clinic LLP CurrentSince Aug 12, 2013 Accepting new patients
Baycare Clinic LLP CurrentSince Aug 12, 2013 Accepting new patients
Signify Health Medical Associates, PLLC Nurse Practitioner CurrentSince Dec 17, 2023 Accepting new patients
Holy Family Memorial Inc Past Accepting new patients
Prevea Clinic, Inc. Past Accepting new patients

Locations

4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037

2733 S Ridge Rd
Green Bay, WI 54304
Phone (920) 497-6200

164 N Broadway
Green Bay, WI 54303
Phone (920) 965-4055

2581 Development Dr
Green Bay, WI 54311
Phone (920) 347-0400

1035 Kepler Dr
Green Bay, WI 54311

811 E Washington Ave
Madison, WI 53703
Phone (469) 466-7420

501 N 10th St
Manitowoc, WI 54220
Phone (920) 682-6376

1111 Bayshore Dr
Manitowoc, WI 54220
Phone (920) 682-6376

601 Reed Ave
Manitowoc, WI 54220
Phone (920) 682-8841

719 Doctors Ct
Oshkosh, WI 54901
Phone (920) 235-0066

Organizations & group practices 5

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": "1165795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712707200000",
    "number": "1336209402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1035 KEPLER DR",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543118320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 BAYSHORE DR",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542205548",
            "telephone_number": "920-682-6376",
            "fax_number": "920-652-0115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUKOWATY",
        "first_name": "CATHY",
        "middle_name": "M",
        "name_prefix": "Ms.",
        "credential": "APNP, MSN, BSN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-11",
        "last_updated": "2024-04-10",
        "certification_date": "2024-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "WI",
            "license": "1120-033",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "1120",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43861300",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "csukowaty54676@direct.myadvocateaurora.org",
            "affiliation": "N",
            "address_1": "501 N 10th St",
            "city": "Manitowoc",
            "state": "WI",
            "country_code": "US",
            "postal_code": "542204039",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Manitowoc, WI

Sources for this page

Verify at the official NPI Registry.