Individual provider Active NPI

Kristin M Schroederus, MD

  • Allergy & Immunology Physician
  • Mequon, WI
National Provider Identifier
1649314832
Registry record updated Nov 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Allergy & Immunology PhysicianTaxonomy code 207K00000X
License
55114 Issued in WI
Practice address
13133 N Port Washington Rd
Suite G-18
Mequon, WI 53097-2419
Phone
(262) 243-5000
Fax
(262) 243-5317
NPI assigned
Feb 19, 2007
Last updated
Nov 9, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy & Immunology Physician 207K00000X 55114 WI Primary
Pediatric Allergy/Immunology Physician 2080P0201X 55114 WI

Addresses

Primary practice location

13133 N Port Washington Rd
Suite G-18
Mequon, WI 53097-2419

Mailing address

788 N Jefferson St
Suite 300/Attn, Kaaren Butzen
Milwaukee, WI 53202-3718
Phone (414) 272-8950

Other identifiers 1

IdentifierTypeStateIssuer
1649314832MedicaidWI

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110922000590 WI Practitioner - Allergy/ImmunologyPractitioner - Pediatric Medicine 3476590753 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Allergy/ImmunologyAlso: Pediatric Medicine
Education
Medical College of Wisconsin, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Madison Medical Affiliates IncGroup PAC ID 5991606337, 86 clinicians

Practice addresses (Care Compare)

13133 N Port Washington Rd
Suite G 18
Mequon, WI 53097-2420
Phone (262) 243-5000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Madison Medical Affiliates, Inc. CurrentSince Oct 1, 2011 Accepting new patients
Diane L Ozog, MDSC Allergy & Immunology Past Accepting new patients
Columbia St. Mary's Hospital Milwaukee, Inc PastSince Oct 1, 2011 Accepting new patients

Locations

7423 Solutions Ctr
Chicago, IL 60677

13133 N Port Washington Rd
Ste G-18
Mequon, WI 53097
Phone (262) 243-5000

13133 N Port Washington Rd
Ste G01
Mequon, WI 53097
Phone (262) 243-2500

788 N Jefferson St
Ste 300ATTN
Milwaukee, WI 53202

788 N Jefferson St
Ste 401
Milwaukee, WI 53202
Phone (414) 226-4020

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/11299/brand/1/csg/1/fhir/r4

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": "1171843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478649600000",
    "number": "1649314832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "788 N JEFFERSON ST",
            "address_2": "SUITE 300/ATTN, KAAREN BUTZEN",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532023718",
            "telephone_number": "414-272-8950",
            "fax_number": "414-272-0859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13133 N PORT WASHINGTON RD",
            "address_2": "SUITE G-18",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530972419",
            "telephone_number": "262-243-5000",
            "fax_number": "262-243-5317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHROEDERUS",
        "first_name": "KRISTIN",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-19",
        "last_updated": "2016-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "WI",
            "license": "55114",
            "primary": true
        },
        {
            "code": "2080P0201X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Allergy/Immunology",
            "state": "WI",
            "license": "55114",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1649314832",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mequon, WI

Sources for this page

Verify at the official NPI Registry.