Individual provider Active NPI

Todd Harold Bruss, ATC, LAT, CSCS, PA-C

  • Physician Assistant
  • Green Bay, WI
National Provider Identifier
1417178443
Registry record updated Apr 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
3058 Issued in WI
Practice address
1110 Kepler Dr
Green Bay, WI 54311-8306
Phone
(920) 288-5555
Fax
(920) 288-5550
NPI assigned
May 1, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 3058 WI Primary
Athletic Trainer 2255A2300X 350-039 WI

Addresses

Primary practice location

1110 Kepler Dr
Green Bay, WI 54311-8306

Mailing address

1035 Kepler Dr
Green Bay, WI 54311-8320
Phone (920) 490-9046

Other identifiers 1

IdentifierTypeStateIssuer
1417178443MedicaidWI

Electronic endpoints 3

TypeEndpointUseAffiliation
Direct Messaging Address tbruss62592@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/
Direct Messaging Address tbruss62592@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
I20130214000250 WI Practitioner - Physician Assistant 7113171489 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Baycare Clinic LLPGroup PAC ID 4385554328, 197 clinicians

Practice addresses (Care Compare)

1160 Kepler Dr
Green Bay, WI 54311-8321
Phone (920) 288-5555

1910 Alabama St
Sturgeon Bay, WI 54235-3532
Phone (920) 743-4844

2845 Greenbrier Rd
Green Bay, WI 54311-6519

3003 University Dr
Marinette, WI 54143-4110
Phone (715) 735-3187

Hospital & facility affiliations

  • Aurora Baycare Medical Ctr Hospital, Green Bay, WI, CCN 520193
  • Aurora Medical Center Bay Area Hospital, Marinette, WI, CCN 520113
  • Door County Medical Center Hospital, Sturgeon Bay, WI, CCN 521358

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3058WIMDDentist
350-039WIMDAthletic Trainer

Practice roles

OrganizationSpecialtyStatusNew patients
Baycare Clinic LLP CurrentSince Aug 18, 2015 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Jun 1, 2013 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Jun 1, 2013 Accepting new patients
Arthroscopic Surgery Center, LLC Past Accepting new patients

Locations

277 N Altenhofen Dr
Grand Chute, WI 54913
Phone (920) 212-3609

1035 Kepler Dr
Green Bay, WI 54311

1160 Kepler Dr
Green Bay, WI 54311
Phone (920) 288-5400

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

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

1110 Kepler Dr
Green Bay, WI 54311
Phone (920) 288-4712

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

3003 University Dr
Marinette, WI 54143
Phone (715) 735-4200

1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056

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

108 S 10th Ave
Sturgeon Bay, WI 54235
Phone (920) 746-7955

1910 Alabama St
Sturgeon Bay, WI 54235
Phone (920) 746-7200

Interoperability endpoints

  • Direct secure messaging: tbruss62592@direct.myadvocateaurora.org

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.

Hospital & facility affiliations 6

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": "1177977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776729600000",
    "number": "1417178443",
    "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",
            "telephone_number": "920-490-9046",
            "fax_number": "920-405-8005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 KEPLER DR",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543118306",
            "telephone_number": "920-288-5555",
            "fax_number": "920-288-5550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUSS",
        "first_name": "TODD",
        "middle_name": "HAROLD",
        "name_prefix": "Mr.",
        "credential": "ATC, LAT, CSCS, PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-01",
        "last_updated": "2026-04-21",
        "certification_date": "2026-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "3058",
            "primary": true
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "WI",
            "license": "350-039",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1417178443",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tbruss62592@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1160 Kepler Dr",
            "city": "Green Bay",
            "state": "WI",
            "country_code": "US",
            "postal_code": "543088970",
            "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": "1160 Kepler Dr",
            "city": "Green Bay",
            "state": "WI",
            "country_code": "US",
            "postal_code": "543088970",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tbruss62592@direct.myadvocateaurora.org",
            "affiliation": "N",
            "address_1": "1160 Kepler Dr",
            "city": "Green Bay",
            "state": "WI",
            "country_code": "US",
            "postal_code": "543088970",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.