Individual provider Active NPI

Caitlin Wiedenhoeft

  • Physician Assistant
  • Milwaukee, WI
National Provider Identifier
1710357223
Registry record updated Oct 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
3672 - 23 Issued in WI
Practice address
3305 S 20TH St Ste 100
Milwaukee, WI 53215-4940
Phone
(414) 645-1984
NPI assigned
Sep 28, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 14, 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 3672 - 23 WI Primary

Addresses

Primary practice location

3305 S 20TH St Ste 100
Milwaukee, WI 53215-4940

Mailing address

PO Box 735044
Chicago, IL 60673-5044
Phone (800) 326-2250

Other identifiers 1

IdentifierTypeStateIssuer
100048644MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address cwiedenhoeft30917@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

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
I20151016000320 WI Practitioner - Physician Assistant 1153630009 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians
Advantage Physical Therapy and Sports Rehab, LLCGroup PAC ID 8022016336, shared by 3 NPIs, 289 clinicians

Practice addresses (Care Compare)

1020 N 12TH St
Milwaukee, WI 53233-1308
Phone (414) 219-3056

3305 S 20TH St
Milwaukee, WI 53215-4940
Phone (414) 385-2914

3503 E Layton Ave
Unit 100
Cudahy, WI 53110-1408
Phone (414) 489-0270

Hospital & facility affiliations

  • Aurora St Lukes Medical Center Hospital, Milwaukee, WI, CCN 520138

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3672WIMDPhysical Therapist
3672 - 23WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeshore Medical Clinic, LLC CurrentSince Feb 1, 2020 Accepting new patients
Aurora Advanced Healthcare, Inc. CurrentSince Oct 1, 2025 Accepting new patients
Lakeshore Medical Clinic LTD CurrentSince Feb 1, 2020 Accepting new patients
Aurora Advanced Healthcare Inc CurrentSince Oct 1, 2025 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Sep 28, 2015 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Sep 28, 2015 Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients

Locations

3003 W Good Hope Rd
Glendale, WI 53209
Phone (414) 352-3100

12203 N Corporate Pkwy
Mequon, WI 53092
Phone (262) 387-8200

4111 W Mitchell St
Milwaukee, WI 53215
Phone (414) 385-8800

1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056

3305 S 20th St
Ste 100
Milwaukee, WI 53215
Phone (414) 645-1808

4111 W Mitchell St
Ste 300
Milwaukee, WI 53215
Phone (414) 385-8800

S74W16775 Janesville Rd
Muskego, WI 53150
Phone (414) 422-4747

2000 E Layton Ave
St Francis, WI 53235
Phone (414) 744-7880

Interoperability endpoints

  • Direct secure messaging: cwiedenhoeft30917@direct.myadvocateaurora.org

Organizations & group practices 7

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 2

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": "1443398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728864000000",
    "number": "1710357223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 735044",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606735044",
            "telephone_number": "800-326-2250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3305 S 20TH ST STE 100",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532154940",
            "telephone_number": "414-645-1984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIEDENHOEFT",
        "first_name": "CAITLIN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-28",
        "last_updated": "2024-10-14",
        "certification_date": "2024-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "3672 - 23",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100048644",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cwiedenhoeft30917@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "4111 W Mitchell St Ste 300",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532151748",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "4111 W Mitchell St Ste 300",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532151748",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.