NPIMap

Individual provider Active NPI

Mary Elizabeth Burnett, M.D.

  • Allergy Physician
  • Wauwatosa, WI
National Provider Identifier
1437310596
Registry record updated Jan 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Allergy PhysicianTaxonomy code 207KA0200X
License
63139 Issued in WI
Practice address
2500 N Mayfair Rd
Suite 220
Wauwatosa, WI 53226-1415
Phone
(414) 475-9101
Fax
(414) 475-9203
NPI assigned
Jun 21, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy Physician 207KA0200X 63139 WI Primary
Internal Medicine Physician 207R00000X 4301092230 MI

Addresses

Primary practice location

2500 N Mayfair Rd
Suite 220
Wauwatosa, WI 53226-1415

Mailing address

2500 N Mayfair Rd
Suite 220
Wauwatosa, WI 53226-1409
Phone (414) 475-9101

Other names 1

  • Mary Elizabeth Castillo Former name

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
I20150416001960 WI Practitioner - Allergy/Immunology 6901033018 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Allergy/Immunology
Education
Medical College of Wisconsin, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Prohealth Medical Group IncGroup PAC ID 3476465188, 475 clinicians

Practice addresses (Care Compare)

2130 Big Bend Rd
Waukesha, WI 53189-7624
Phone (262) 928-7555

Hospital & facility affiliations

  • Waukesha Memorial Hospital Hospital, Waukesha, WI, CCN 520008

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
63139WIMDAllergy Physician
4301092230MIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prohealth Medical Group Inc. Internal Medicine CurrentSince Apr 1, 2021 Accepting new patients
Prohealth Medical Group Inc Internal Medicine CurrentSince Apr 1, 2021 Accepting new patients
Prohealth Medical Group Inc Internal Medicine Past Accepting new patients

Locations

1111 Delafield St
Ste 300
Waukesha, WI 53188
Phone (262) 446-0955

2130 Big Bend Rd
Waukesha, WI 53189
Phone (262) 928-7555

N17W24100 Riverwood Dr
Waukesha, WI 53188
Phone (262) 820-3093

Interoperability endpoints

  • Direct secure messaging: mburnett60396@direct.phci.org

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 1

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": "1214006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1422403200000",
    "number": "1437310596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 N MAYFAIR RD",
            "address_2": "SUITE 220",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532261409",
            "telephone_number": "414-475-9101",
            "fax_number": "414-475-9203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 N MAYFAIR RD",
            "address_2": "SUITE 220",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532261415",
            "telephone_number": "414-475-9101",
            "fax_number": "414-475-9203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURNETT",
        "first_name": "MARY",
        "middle_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-21",
        "last_updated": "2015-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207KA0200X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology, Allergy",
            "state": "WI",
            "license": "63139",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301092230",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "CASTILLO",
            "middle_name": "ELIZABETH",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Wauwatosa, WI

Sources for this page

Verify at the official NPI Registry.