NPIMap

Individual provider Active NPI

Kimberly J Wilcox, CRNA

  • Registered Nurse
  • Green Bay, WI
National Provider Identifier
1629277587
Registry record updated Mar 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
148836 Issued in WI
Practice address
744 S Webster Ave
Green Bay, WI 54301-3505
Phone
(920) 433-3500
NPI assigned
Jul 12, 2007
Last updated
Mar 30, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 072750 IL
Registered Nurse 163W00000X 148836 WI Primary

Addresses

Primary practice location

744 S Webster Ave
Green Bay, WI 54301-3505

Mailing address

225 S Executive Dr
Brookfield, WI 53005-4257
Phone (262) 787-4026

Other identifiers 1

IdentifierTypeStateIssuer
44339100MedicaidWI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kwilcox18426@direct.sanfordhealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD, IA, TX3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20081126000063 SD Practitioner - Certified Registered Nurse Anesthetist (Crna) 8820040959 Reassigns benefits to 4 organizations
I20190725001430 IA Practitioner - Certified Registered Nurse Anesthetist (Crna) 8820040959 Reassigns benefits to 1 organization
I20210311000184 TX Practitioner - Certified Registered Nurse Anesthetist (Crna) 8820040959 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Avera McKennanGroup PAC ID 0345157103, 957 clinicians

Practice addresses (Care Compare)

1325 S Cliff Ave
Sioux Falls, SD 57105-1007

6100 S Louise Ave
Sioux Falls, SD 57108-6029

909 N Iowa Ave
Dell Rapids, SD 57022-1231
Phone (605) 428-5431

910 E 20TH St
Sioux Falls, SD 57105-1012
Phone (605) 334-6730

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
148836WIMDRegistered Nurse
072750ILMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Health Network Registered Nurse Current Accepting new patients
Avera McKennan CurrentSince Jun 10, 2019 Accepting new patients
Rosebud Indian Health Service CurrentSince Mar 8, 2021 Accepting new patients
Sacred Heart Health Services CurrentSince Jul 23, 2019 Accepting new patients
Sioux Falls Specialty Hospital, LLP CurrentSince Aug 25, 2025 Accepting new patients
Sioux Falls Specialty Hospital, LLP CurrentSince Aug 25, 2025 Accepting new patients
Anesthesia Consultants PC Nurse Anesthetist, Certified Registered CurrentSince May 22, 2019 Accepting new patients
Avera McKennan Nurse Anesthetist, Certified Registered CurrentSince Jun 10, 2019 Accepting new patients
Avera McKennan Current Accepting new patients
Sanford Health Network CurrentSince Sep 2, 2019 Accepting new patients
Sacred Heart Health Services Registered Nurse CurrentSince Jul 23, 2019 Accepting new patients
Rosebud Indian Health Service CurrentSince Mar 8, 2021 Accepting new patients
Sacred Heart Health Services Current Accepting new patients
Bellin Anesthesia Associates, S.C. Past Accepting new patients

Locations

2720 Stone Park Blvd
Sioux City, IA 51104
Phone (712) 259-3000

2730 Pierce St
Sioux City, IA 51104
Phone (712) 224-3380

2905 3rd Ave SE
Aberdeen, SD 57401
Phone (605) 226-5500

909 N Iowa Ave
Dell Rapids, SD 57022
Phone (605) 428-5431

1305 W 18th St
Sioux Falls, SD 57105
Phone (605) 312-7300

910 E 20th St
Sioux Falls, SD 57105
Phone (602) 338-7098

20 S Plum St
Vermillion, SD 57069
Phone (605) 624-2611

501 Summit St
Yankton, SD 57078
Phone (605) 655-1201

Interoperability endpoints

  • Direct secure messaging: kwilcox18426@direct.sanfordhealth.org

Organizations & group practices 15

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.

View all 15

Hospital & facility affiliations 24

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1184198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648598400000",
    "number": "1629277587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 S EXECUTIVE DR",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530054257",
            "telephone_number": "262-787-4026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "744 S WEBSTER AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543013505",
            "telephone_number": "920-433-3500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILCOX",
        "first_name": "KIMBERLY",
        "middle_name": "J",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-12",
        "last_updated": "2022-03-30",
        "certification_date": "2022-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IL",
            "license": "072750",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WI",
            "license": "148836",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "44339100",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kwilcox18426@direct.sanfordhealth.org",
            "affiliation": "N",
            "address_1": "2905 3rd Ave SE # See",
            "city": "Aberdeen",
            "state": "SD",
            "country_code": "US",
            "postal_code": "574015420",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2022; 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.