Individual provider Active NPI

Regan Bolt, AUD

  • Audiologist
  • Greenfield, WI
National Provider Identifier
1417706490
Registry record updated Nov 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
1065-156 Issued in WI
Practice address
9000 W Sura LN
Greenfield, WI 53228-3477
Phone
(414) 246-6800
NPI assigned
May 14, 2024
Last updated
Nov 18, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 1065-156 WI Primary

Addresses

Primary practice location

9000 W Sura LN
Greenfield, WI 53228-3477

Mailing address

PO Box 735044
Chicago, IL 60673-5044
Phone (800) 326-2250

Other identifiers 1

IdentifierTypeStateIssuer
100281767MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address rbolt368630@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
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240717000990 WI Practitioner - Qualified Audiologist 4486199288 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Qualified Audiologist
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aurora Advanced Healthcare, Inc.Group PAC ID 3375625833, 1,107 clinicians
Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians

Practice addresses (Care Compare)

16985 W Bluemound Rd
Brookfield, WI 53005-5909
Phone (262) 641-8400

9000 W Sura LN
Greenfield, WI 53228-3477
Phone (414) 246-6800

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1065WIMDPhysical Therapist
1065-156WIMDAudiologist

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeshore Medical Clinic, LLC CurrentSince Jul 1, 2024 Accepting new patients
Aurora Advanced Healthcare, Inc. CurrentSince Jul 1, 2024 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Jul 1, 2024 Accepting new patients
Aurora Medical Group, Inc. Audiologist CurrentSince Jul 1, 2024 Accepting new patients
Aurora Advanced Healthcare Inc CurrentSince Jul 1, 2024 Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients

Locations

16985 W Bluemound Rd
Brookfield, WI 53005
Phone (262) 641-8400

3003 W Good Hope Rd
Glendale, WI 53209
Phone (414) 352-3100

12203 N Corporate Pkwy
Mequon, WI 53092
Phone (262) 387-8200

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

9000 W Sura Ln
Milwaukee, WI 53228
Phone (414) 246-6500

S68W15500 Janesville Rd
Muskego, WI 53150
Phone (414) 422-2180

S74W16775 Janesville Rd
Muskego, WI 53150
Phone (414) 422-4747

2000 E Layton Ave
St Francis, WI 53235
Phone (414) 744-7880

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1715644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731888000000",
    "number": "1417706490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 735044",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606735044",
            "telephone_number": "800-326-2250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9000 W SURA LN",
            "city": "GREENFIELD",
            "state": "WI",
            "postal_code": "532283477",
            "telephone_number": "414-246-6800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLT",
        "first_name": "REGAN",
        "credential": "AUD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-05-14",
        "last_updated": "2024-11-18",
        "certification_date": "2024-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "WI",
            "license": "1065-156",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100281767",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rbolt368630@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "9000 W Sura Ln",
            "city": "Greenfield",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532283477",
            "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": "9000 W Sura Ln",
            "city": "Greenfield",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532283477",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Greenfield, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.