Individual provider Active NPI

Caitlin N Carlson, PA-C

  • Physician Assistant
  • Mount Pleasant, WI
National Provider Identifier
1588211320
Registry record updated Aug 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
4860 Issued in WI
Practice address
3801 Spring St
Mount Pleasant, WI 53405-1667
Phone
(262) 687-4011
NPI assigned
Aug 26, 2019
Last updated
Aug 26, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 4860 WI Primary

Addresses

Primary practice location

3801 Spring St
Mount Pleasant, WI 53405-1667

Mailing address

10192 W Waldo Ave
Beach Park, IL 60099-3665
Phone (224) 772-4417

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
I20191008001950 WI Practitioner - Physician Assistant 0042541989 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Emergency Medicine Specialists SCGroup PAC ID 8729975461, 220 clinicians

Practice addresses (Care Compare)

10180 Washington Ave
Mount Pleasant, WI 53177-1604
Phone (262) 687-7550

3801 Spring St
Mount Pleasant, WI 53405-1667
Phone (262) 687-4011

3807 Spring St
Mount Pleasant, WI 53405-1667
Phone (262) 687-8173

5000 W Chambers St
Milwaukee, WI 53210-1650
Phone (414) 447-2000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4860WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ascension Medical Group-Southeast Wisconsin Inc Physician Assistant CurrentSince Nov 1, 2019 Accepting new patients
Integrated Therapeutic Massage LLC PastSince Aug 1, 2021 Accepting new patients

Locations

1506 S Oneida St
Appleton, WI 54915
Phone (920) 730-4950

13950 W Capitol Dr
Brookfield, WI 53005
Phone (414) 302-5400

19333 W North Ave
Brookfield, WI 53045
Phone (262) 785-2000

10101 S 27th St
Franklin, WI 53132
Phone (414) 325-4700

375 W River Woods Pkwy
Glendale, WI 53212
Phone (414) 326-1500

2301 N Lake Dr
Milwaukee, WI 53211
Phone (414) 270-4932

3237 S 16th St
Milwaukee, WI 53215
Phone (414) 647-5000

5000 W Chambers St
Milwaukee, WI 53210
Phone (414) 447-2089

3801 Spring St
Mount Pleasant, WI 53405
Phone (262) 636-4011

500 S Oakwood Rd
Oshkosh, WI 54904
Phone (920) 223-0501

13111 N Port Washington Rd
Thiensville, WI 53097
Phone (262) 243-7300

201 N Mayfair Rd
Wauwatosa, WI 53226
Phone (414) 259-7200

201 N Mayfair Rd
Fl 2
Wauwatosa, WI 53226
Phone (414) 771-8228

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1566777600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566777600000",
    "number": "1588211320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10192 W WALDO AVE",
            "city": "BEACH PARK",
            "state": "IL",
            "postal_code": "600993665",
            "telephone_number": "224-772-4417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3801 SPRING ST",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "534051667",
            "telephone_number": "262-687-4011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLSON",
        "first_name": "CAITLIN",
        "middle_name": "N",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-26",
        "last_updated": "2019-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "4860",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Pleasant, WI

Sources for this page

Verify at the official NPI Registry.