Individual provider Active NPI

Kristen L Dudas, PA-C

  • Physician Assistant
  • Wauwatosa, WI
National Provider Identifier
1376679092
Registry record updated Apr 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1405 Issued in WI
Practice address
2885 N Mayfair Rd
Wauwatosa, WI 53222-4404
Phone
(414) 771-6780
Fax
(414) 238-2424
NPI assigned
Feb 26, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1405 WI Primary

Addresses

Primary practice location

2885 N Mayfair Rd
Wauwatosa, WI 53222-4404

Mailing address

10001 W Innovation Dr Ste 200
Wauwatosa, WI 53226-4851
Phone (414) 771-6780

Other identifiers 1

IdentifierTypeStateIssuer
41932600MedicaidWI

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
I20040304001091 WI Practitioner - Physician Assistant 4587552336 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advanced Ear Nose and Throat Specialists, SCGroup PAC ID 9335106319, 33 clinicians

Practice addresses (Care Compare)

10610 N Port Washington Rd
Mequon, WI 53092-5013
Phone (888) 938-3838

2885 N Mayfair Rd
Milwaukee, WI 53222-4404
Phone (888) 938-3838

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Ear Nose & Throat Specialists, SC CurrentSince Nov 2, 2015 Accepting new patients
Central Dupage Physician Group Past Accepting new patients
Advanced Ear Nose & Throat Specialists, PLLC PastSince Dec 14, 2019 Accepting new patients

Locations

247 S Nicolet Rd
Appleton, WI 54914

2654 S Oneida St
Stop 102
Green Bay, WI 54304

8500 75th St
Ste 101
Kenosha, WI 53142
Phone (262) 653-2260

4781 Hayes Rd
Ste 101
Madison, WI 53704

10610 N Port Washington Rd
Mequon, WI 53092
Phone (262) 923-7879

500 W Drexel Ave
Ste 300
Oak Creek, WI 53154

2108 Kohler Memorial Dr
Ste 100
Sheboygan, WI 53081

10001 W Innovation Dr
Ste 200
Wauwatosa, WI 53226

2885 N Mayfair Rd
Wauwatosa, WI 53222
Phone (414) 615-7044

Organizations & group practices 4

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": "1172448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617667200000",
    "number": "1376679092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10001 W INNOVATION DR STE 200",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532264851",
            "telephone_number": "414-771-6780",
            "fax_number": "414-238-2424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2885 N MAYFAIR RD",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532224404",
            "telephone_number": "414-771-6780",
            "fax_number": "414-238-2424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUDAS",
        "first_name": "KRISTEN",
        "middle_name": "L",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-26",
        "last_updated": "2021-04-06",
        "certification_date": "2021-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "1405",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41932600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wauwatosa, WI

Sources for this page

Verify at the official NPI Registry.