Active NPI
Bonnie S Mueller-Waigand, PA
- Physician Assistant
- Kewaunee, WI
National Provider Identifier
1649254384
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 1208
- Practice address
- 575 4TH St
Kewaunee, WI 54216-1785 - Phone
- (920) 388-4640
- NPI assigned
- Dec 6, 2005
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1208 | WI | Primary |
Addresses
Primary practice location
575 4TH St
Kewaunee, WI 54216-1785
Mailing address
PO Box 22487
Green Bay, WI 54305-2487
Phone (920) 445-7222
Other practice location 1
831 Parker Ave
Algoma, WI 54201-1808
Phone (920) 487-3676
Other practice location 2
723 S Wisconsin St
Pulaski, WI 54162-9303
Phone (920) 822-1100
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1044380 | Other | NATIONAL COMMISSION ON CERTIFIED PHYSICIANS ASSISTANTS | |
| 1208-023 | Other | WI | LICENSE |
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 1999
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2020 S Webster Ave
Accounting
Green Bay, WI 54301-3505
575 4TH St
Kewaunee, WI 54216-1785
Phone (920) 388-4640
744 S Webster Ae
Green Bay, WI 54301-3505
744 S Webster Ave
Green Bay, WI 54301-3505
Hospital & facility affiliations
- Bellin Home Health Agency
- Unity Hospice
- Bellin Memorial Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1208 | WI | MD | Occupational Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bellin Memorial Hospital Inc | Current | Accepting new patients | |
| Bellin Memorial Hospital Inc | Past | Accepting new patients |
Locations
744 S Webster Ave
Green Bay, WI 54301
Phone (920) 433-6025
Interoperability endpoints
- bmuellerwaigand32413@direct.thedacare.org
- bmuellerwaigand924481@direct.emplifyhealth.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.
-
- Rural Health Clinic/Center
- Algoma, WI
- NPI 1609838473
-
- Family Medicine Physician
- Green Bay, WI
- NPI 1407033111
-
- Family Medicine Physician
- Brillion, WI
- NPI 1962464784
Hospital & facility affiliations 3
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Home Health Agency
- Green Bay, WI
- NPI 1831246404
-
- General Acute Care Hospital
- Green Bay, WI
- NPI 1891740585
-
- Community Based Hospice Care Agency
- De Pere, WI
- NPI 1194797910
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133827200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1594252800000",
"number": "1649254384",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 22487",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543052487",
"telephone_number": "920-445-7222",
"fax_number": "920-445-7289"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "575 4TH ST",
"city": "KEWAUNEE",
"state": "WI",
"postal_code": "542161785",
"telephone_number": "920-388-4640"
}
],
"practiceLocations": [
{
"address_1": "831 Parker Ave",
"address_purpose": "LOCATION",
"city": "Algoma",
"state": "WI",
"postal_code": "542011808",
"country_code": "US",
"telephone_number": "920-487-3676",
"fax_number": "920-487-3084",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "723 S Wisconsin St",
"address_purpose": "LOCATION",
"city": "Pulaski",
"state": "WI",
"postal_code": "541629303",
"country_code": "US",
"telephone_number": "920-822-1100",
"fax_number": "920-822-5731",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MUELLER-WAIGAND",
"first_name": "BONNIE",
"middle_name": "S",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-12-06",
"last_updated": "2020-07-09",
"certification_date": "2020-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WI",
"license": "1208",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NATIONAL COMMISSION ON CERTIFIED PHYSICIANS ASSISTANTS",
"identifier": "1044380",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "1208-023",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kewaunee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.