Active NPI
Kris Rudy Vanderkooy
- Internal Medicine Physician
- Brookfield, WI
National Provider Identifier
1467625178
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 53968
- Practice address
- 1350 S Sunny Slope Rd
Sunnyslope Primary Care Clinic
Brookfield, WI 53005-7060 - Phone
- (414) 805-9600
- Fax
- (414) 805-9645
- NPI assigned
- Apr 2, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 53968 | WI | Primary |
Addresses
Primary practice location
1350 S Sunny Slope Rd
Sunnyslope Primary Care Clinic
Brookfield, WI 53005-7060
Mailing address
1350 S Sunny Slope Rd
Sunnyslope Primary Care Clinic
Brookfield, WI 53005-7060
Phone (414) 805-9600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467625178 | Medicaid | WI |
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
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 53968 | WI | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1207094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1308787200000",
"number": "1467625178",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1350 S SUNNY SLOPE RD",
"address_2": "SUNNYSLOPE PRIMARY CARE CLINIC",
"city": "BROOKFIELD",
"state": "WI",
"postal_code": "530057060",
"telephone_number": "414-805-9600",
"fax_number": "414-805-9645"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1350 S SUNNY SLOPE RD",
"address_2": "SUNNYSLOPE PRIMARY CARE CLINIC",
"city": "BROOKFIELD",
"state": "WI",
"postal_code": "530057060",
"telephone_number": "414-805-9600",
"fax_number": "414-805-9645"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDERKOOY",
"first_name": "KRIS",
"middle_name": "RUDY",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-04-02",
"last_updated": "2011-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "WI",
"license": "53968",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1467625178",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brookfield, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.