NPIMap

Individual provider Active NPI

Michaela Machurick, ACNPC-AG

  • Nurse Practitioner
  • Appleton, WI
National Provider Identifier
1366137333
Registry record updated Dec 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
13685-33 Issued in WI
Practice address
5045 W Grande Market Dr
Appleton, WI 54913-8517
Phone
(920) 886-9380
NPI assigned
Apr 6, 2023
Last updated
Dec 21, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2023

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 13685-33 WI Primary

Addresses

Primary practice location

5045 W Grande Market Dr
Appleton, WI 54913-8517

Mailing address

301 W 17TH St
Kaukauna, WI 54130-3105
Phone (920) 809-8696

Other identifiers 1

IdentifierTypeStateIssuer
100239012MedicaidWI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mmachurick265084@ewd.direct.hshs.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230608002956 WI Practitioner - Nurse Practitioner 9133586969 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ascension Medical Group-Fox Valley Wisconsin, IncGroup PAC ID 0244142420, shared by 2 NPIs, 260 clinicians

Practice addresses (Care Compare)

1506 S Oneida St
Appleton, WI 54915-1305
Phone (920) 738-2000

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Ascension Calumet Hospital, Inc CurrentSince Dec 6, 2023 Accepting new patients
Ascension Medical Group-Fox Valley Wisconsin, Inc CurrentSince Dec 6, 2023 Accepting new patients
Ascension Medical Group-Fox Valley Wisconsin, Inc CurrentSince Dec 6, 2023 Accepting new patients

Locations

1501 S Madison St
Appleton, WI 54915
Phone (920) 730-4435

1506 S Oneida St
Appleton, WI 54915
Phone (920) 730-4950

5045 W Grande Market Dr
Appleton, WI 54913
Phone (920) 747-0505

614 Memorial Dr
Chilton, WI 53014
Phone (800) 458-4042

835 S Van Buren St
Green Bay, WI 54301
Phone (888) 901-7246

1420 Algoma St
New London, WI 54961
Phone (920) 828-8300

2700 W 9th Ave
Oshkosh, WI 54904
Phone (920) 223-0220

Interoperability endpoints

  • Direct secure messaging: mmachurick265084@ewd.direct.hshs.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

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": "1680739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703116800000",
    "number": "1366137333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 W 17TH ST",
            "city": "KAUKAUNA",
            "state": "WI",
            "postal_code": "541303105",
            "telephone_number": "920-809-8696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5045 W GRANDE MARKET DR",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549138517",
            "telephone_number": "920-886-9380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACHURICK",
        "first_name": "MICHAELA",
        "credential": "ACNPC-AG",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-04-06",
        "last_updated": "2023-12-21",
        "certification_date": "2023-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "13685-33",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100239012",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mmachurick265084@ewd.direct.hshs.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "1726 Shawano Ave",
            "city": "Green Bay",
            "state": "WI",
            "country_code": "US",
            "postal_code": "543033216",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

Verify at the official NPI Registry.