Individual provider Active NPI

Vada Brooke Murray, PA

  • Physician Assistant
  • Milwaukee, WI
National Provider Identifier
1629808829
Registry record updated Aug 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
507 N 17TH St
Milwaukee, WI 53233-2104
Phone
(224) 688-9597
NPI assigned
Aug 3, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2024

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 Primary

Addresses

Primary practice location

507 N 17TH St
Milwaukee, WI 53233-2104

Mailing address

15316 Timber Ridge LN
Holland, MI 49424-6185
Phone (224) 688-9597

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
I20241212002783 WI Practitioner - Physician Assistant 2163958257 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2301 N Lake Dr
Milwaukee, WI 53211-4508

2311 N Prospect Ave
Milwaukee, WI 53211-4445
Phone (414) 319-3000

2323 N Lake Dr
Milwaukee, WI 53211-4508
Phone (414) 585-1000

801 S 70TH St
West Allis, WI 53214-3147
Phone (414) 773-6600

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Columbia St. Mary's Hospital Milwaukee Inc CurrentSince Dec 2, 2024 Accepting new patients
Columbia St. Mary's Hospital Milwaukee, Inc CurrentSince Dec 2, 2024 Accepting new patients
Columbia St. Mary's Hospital Milwaukee, Inc Past Accepting new patients

Locations

2311 N Prospect Ave
Milwaukee, WI 53211
Phone (414) 319-3000

801 S 70th St
West Allis, WI 53214
Phone (414) 773-6600

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 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": "1722643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722643200000",
    "number": "1629808829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15316 TIMBER RIDGE LN",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494246185",
            "telephone_number": "224-688-9597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "507 N 17TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532332104",
            "telephone_number": "224-688-9597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MURRAY",
        "first_name": "VADA",
        "middle_name": "BROOKE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-03",
        "last_updated": "2024-08-03",
        "certification_date": "2024-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.