Individual provider Active NPI

Mary P Gospodarek, APNP

  • Nurse Practitioner
  • Two Rivers, WI
National Provider Identifier
1386683563
Registry record updated Nov 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
1539 Issued in WI
Practice address
2219 Garfield St
Two Rivers, WI 54241
Phone
(920) 793-2281
NPI assigned
Jun 5, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 22, 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 1539 WI Primary

Addresses

Primary practice location

2219 Garfield St
Two Rivers, WI 54241

Mailing address

2219 Garfield St
Two Rivers, WI 54241-2416
Phone (920) 793-2281

Other identifiers 1

IdentifierTypeStateIssuer
43904900MedicaidWI

Other names 1

  • Mary P Shimek Former name

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address mgospodarek59437@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1539WIMDNurse Practitioner

Interoperability endpoints

  • Direct secure messaging: mgospodarek59437@direct.myadvocateaurora.org

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637539200000",
    "number": "1386683563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2219 GARFIELD ST",
            "city": "TWO RIVERS",
            "state": "WI",
            "postal_code": "542412416",
            "telephone_number": "920-793-2281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2219 GARFIELD ST",
            "city": "TWO RIVERS",
            "state": "WI",
            "postal_code": "54241",
            "telephone_number": "920-793-2281"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOSPODAREK",
        "first_name": "MARY",
        "middle_name": "P",
        "credential": "APNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-05",
        "last_updated": "2021-11-22",
        "certification_date": "2021-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "1539",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43904900",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mgospodarek59437@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2219 Garfield St",
            "city": "Two Rivers",
            "state": "WI",
            "country_code": "US",
            "postal_code": "54241",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "2219 Garfield St",
            "city": "Two Rivers",
            "state": "WI",
            "country_code": "US",
            "postal_code": "54241",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "SHIMEK",
            "middle_name": "P",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Two Rivers, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.