NPIMap

Individual provider Active NPI

Sara Grace Holmberg, ANP

  • Adult Health Nurse Practitioner
  • Hudson, WI
National Provider Identifier
1710232699
Registry record updated May 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
7900 Issued in WI
Practice address
403 Stageline Rd
Hudson, WI 54016-7848
Phone
(715) 531-6800
NPI assigned
Jul 17, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 12, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X R 179752-9 MN
Adult Health Nurse Practitioner 363LA2200X 7900 WI Primary

Addresses

Primary practice location

403 Stageline Rd
Hudson, WI 54016-7848

Mailing address

504 MC Cutcheon Rd
Hudson, WI 54016-7009
Phone (715) 386-4052

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171027002689 WI Practitioner - Nurse Practitioner 0345492690 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hudson Physicians SCGroup PAC ID 2668607557, 62 clinicians

Practice addresses (Care Compare)

2651 Hillcrest Dr
Hudson, WI 54016-4439
Phone (715) 531-6800

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
R 179752-9MNMDAdult Health Nurse Practitioner
7900WIMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Hudson Physicians, S.C. CurrentSince Nov 1, 2017 Accepting new patients
Hudson Physicians, S.C. Current Accepting new patients
Hudson Physicians, S.C. Past Accepting new patients

Locations

840 Spruce St
Baldwin, WI 54002
Phone (715) 235-4274

403 Stageline Rd
Hudson, WI 54016
Phone (715) 386-8880

2651 Hillcrest Dr
Ste 303
Hudson, WI 54016

2651 Hillcrest Dr
Hudson, WI 54016
Phone (630) 632-2648

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 8

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": "1342483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589241600000",
    "number": "1710232699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 MC CUTCHEON RD",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "540167009",
            "telephone_number": "715-386-4052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 STAGELINE RD",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "540167848",
            "telephone_number": "715-531-6800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLMBERG",
        "first_name": "SARA",
        "middle_name": "GRACE",
        "credential": "ANP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-17",
        "last_updated": "2020-05-12",
        "certification_date": "2020-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MN",
            "license": "R 179752-9",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "WI",
            "license": "7900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hudson, WI

Sources for this page

Verify at the official NPI Registry.