Individual provider Active NPI

Mary Felicia Wise, NP

  • Primary Care Nurse Practitioner
  • Milwaukee, WI
National Provider Identifier
1558502153
Registry record updated Jul 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
10008-33 Issued in WI
Practice address
2555 N Martin Luther King Dr
Milwaukee, WI 53212-2709
Phone
(414) 372-8080
Fax
(414) 562-8084
NPI assigned
Mar 12, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 164441-30 WI
Nurse Practitioner 363L00000X 10008-33 WI
Primary Care Nurse Practitioner 363LP2300X 10008-33 WI Primary

Addresses

Primary practice location

2555 N Martin Luther King Dr
Milwaukee, WI 53212-2709

Mailing address

2555 N Martin Luther King Dr
Milwaukee, WI 53212-2709
Phone (414) 267-2641

Other practice location 1

8200 W Silver Spring Dr
Milwaukee, WI 53218-2552
Phone (414) 769-3900 ext. 2835

Other identifiers 1

IdentifierTypeStateIssuer
100104639MedicaidWI

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
I20200915002840 WI Practitioner - Nurse Practitioner 9133547615 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Milwaukee Health Services, Inc.Group PAC ID 7416946884, 27 clinicians

Practice addresses (Care Compare)

2555 N Dr Martin Luther King Dr
Milwaukee, WI 53212-2709
Phone (414) 372-8080

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
164441-30WIMDRegistered Nurse
10008-33WIMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Milwaukee Health Services Inc CurrentSince Sep 7, 2020 Accepting new patients
Milwaukee Health Services, Inc. CurrentSince Sep 7, 2020 Accepting new patients
Milwaukee Health Services, Inc. Current Accepting new patients

Locations

2555 N Mlk Dr
Milwaukee, WI 53212
Phone (414) 267-2022

8200 W Silver Spring Dr
Milwaukee, WI 53218
Phone (414) 760-3900

Interoperability endpoints

  • Direct secure messaging: mwise526512@direct.ochin.org

Organizations & group practices 3

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 2

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": "1236816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719964800000",
    "number": "1558502153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2555 N MARTIN LUTHER KING DR",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532122709",
            "telephone_number": "414-267-2641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2555 N MARTIN LUTHER KING DR",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532122709",
            "telephone_number": "414-372-8080",
            "fax_number": "414-562-8084"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8200 W Silver Spring Dr",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532182552",
            "country_code": "US",
            "telephone_number": "414-769-3900 x2835",
            "fax_number": "414-464-6076",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WISE",
        "first_name": "MARY",
        "middle_name": "FELICIA",
        "name_prefix": "Ms.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-03-12",
        "last_updated": "2024-07-03",
        "certification_date": "2024-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WI",
            "license": "164441-30",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "10008-33",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "WI",
            "license": "10008-33",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100104639",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.