Kristine Braker, NP
Individual provider Active NPI Family Nurse Practitioner · Beaver Dam, WI
NPI 1679633580 · NPPES record last updated Jan 31, 2022
Key facts
- NPI
- 1679633580
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 2985-033 (WI)
- Practice address
- 134 Corporate Dr
Beaver Dam, WI 53916-3116 - Phone
- (920) 356-1000
- NPI assigned
- Dec 11, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 8
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2006
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Prairie Ridge Health Inc
Practice addresses (Care Compare)
301 W Main St
Marshall, WI 53559-9129
Phone (608) 655-8181
Hospital & facility affiliations
- Columbus Community Hospital
- Marshfield Medical Center - Beaver Dam (MMC-BD)
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070213000449 | WI | Practitioner - Nurse Practitioner | 3173525664 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2985-033 | WI | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prairie Ridge Health, Inc. | Current |
Accepting new patients | |
| Watertown Physician Practices LLC | Family | Current | Accepting new patients |
| Prairie Ridge Health, Inc. | Current |
Accepting new patients | |
| Watertown Physician Practices LLC | Current |
Accepting new patients | |
| Prairie Ridge Health, Inc. | Current |
Accepting new patients | |
| Prairie Ridge Health Inc. | Current |
Accepting new patients |
Locations
134 Corporate Dr
Beaver Dam, WI 53916
Phone (920) 356-1000
118 W Maple Ave
Beaver Dam, WI 53916
Phone (920) 356-1000
1515 Park Ave
Columbus, WI 53925
Phone (920) 623-1200
1511 Park Ave
Columbus, WI 53925
Phone (920) 623-3012
334 S Western Ave
Juneau, WI 53039
Phone (920) 261-9610
1507 Doctors Ct
Watertown, WI 53094
Phone (920) 261-4111
125 Hospital Dr
Watertown, WI 53098
Phone (920) 261-4210
Interoperability endpoints
- https://fhir-myrecord.cerner.com/r4/a87187e5-fe2f-447e-bf32-4eeb3954a735/
- kbraker258848@direct-ehr-ssmhc.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 2985-033 | WI | Yes |
Addresses
Primary practice location
134 Corporate Dr
Beaver Dam, WI 53916-3116
Mailing address
1515 Park Ave
Columbus, WI 53925-1618
Phone (920) 623-2200
Other practice location 1
301 W Main St
Marshall, WI 53559-9129
Phone (608) 655-8181
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679633580 | Medicaid | WI |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | KBRAKER258848@DIRECT-EHR-SSMHC.COM | Direct | SSM HEALTHCARE OF WI INC |
| Direct Messaging Address | KBRAKER258848@DIRECT-EHR-SSMHC.COM | Direct | SSM HEALTHCARE OF WI INC |
Other providers in Beaver Dam, WI
- Andrea Michelle Bluel
- Asiedu Boateng
- Kristin Bonilla
- Scott Robert Borkenhagen
- Dennis Lee Bostwick
- Shelby Ann Brandsma
- Kailin M Brath
- Douglas Earl Bricker
- Anthony Thomas Bridgeman
- Megan Brisbois
All providers in Beaver Dam, WI · Family Nurse Practitioner in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 31, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.