NPIMap

Individual provider Active NPI

Mackenzie Rose Vander Bloomen, MSN, FNP-C

  • Nurse Practitioner
  • Green Bay, WI
National Provider Identifier
1740940733
Registry record updated Oct 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
11824-33 Issued in WI
Practice address
1860 Shawano Ave
Green Bay, WI 54303-2667
Phone
(920) 272-1010
NPI assigned
Dec 18, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 13, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered NurseGroup: 193400000X SINGLE SPECIALTY GROUP 163W00000X 230930-30 WI
Nurse Practitioner 363L00000X 11824-33 WI Primary

Addresses

Primary practice location

1860 Shawano Ave
Green Bay, WI 54303-2667

Mailing address

1326 Sand Acres Dr
De Pere, WI 54115-9487
Phone (920) 264-4346

Other names 1

  • Mackenzie Rose Dorow Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mvanderbloomen237737@ewd.direct.hshs.org Direct

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
I20220414000562 WI Practitioner - Nurse Practitioner 4183010473 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1411 N Taylor Dr
Sheboygan, WI 53081-3043
Phone (920) 457-4858

1860 Shawano Ave
Green Bay, WI 54303-2667
Phone (920) 496-4700

3100 Superior Ave
Sheboygan, WI 53081-1948
Phone (920) 459-8300

Hospital & facility affiliations

  • St Vincent Hospital Hospital, Green Bay, WI, CCN 520075
  • St Marys Hospital Medical Ctr Hospital, Green Bay, WI, CCN 520097
  • HSHS St Clare Memorial Hospital Hospital, Oconto Falls, WI, CCN 521310
  • Door County Medical Center Hospital, Sturgeon Bay, WI, CCN 521358

Merit-based Incentive Payment System (MIPS)

Final score
94.81 of 100Reported as apm
Quality
85.98
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
230930-30WIMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis Single Specialty Current Accepting new patients
St. Nicholas Hospital-Sisters of the Third Order of St Francis Single Specialty Current Accepting new patients
St Nicholas Hospital-Sisters of the Third Order of St Francis Single Specialty CurrentSince Apr 1, 2022 Accepting new patients
St Nicholas Hospital-Sisters of the Third Order of St Francis Nurse Practitioner CurrentSince Apr 1, 2022 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis CurrentSince Apr 1, 2022 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis Single Specialty CurrentSince Apr 1, 2022 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis Single Specialty Past Accepting new patients

Locations

835 S Van Buren St
Green Bay, WI 54301
Phone (888) 901-7246

1860 Shawano Ave
Green Bay, WI 54303
Phone (920) 405-1414

3100 Superior Ave
Sheboygan, WI 53081
Phone (800) 472-6710

Interoperability endpoints

  • Direct secure messaging: mvanderbloomen237737@ewd.direct.hshs.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 12

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": "1639785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665619200000",
    "number": "1740940733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1326 SAND ACRES DR",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541159487",
            "telephone_number": "920-264-4346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1860 SHAWANO AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543032667",
            "telephone_number": "920-272-1010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDER BLOOMEN",
        "first_name": "MACKENZIE",
        "middle_name": "ROSE",
        "credential": "MSN, FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-12-18",
        "last_updated": "2022-10-13",
        "certification_date": "2022-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Registered Nurse",
            "state": "WI",
            "license": "230930-30",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "11824-33",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mvanderbloomen237737@ewd.direct.hshs.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "1860 Shawano Ave",
            "city": "Green Bay",
            "state": "WI",
            "country_code": "US",
            "postal_code": "543032667",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MACKENZIE",
            "last_name": "DOROW",
            "middle_name": "ROSE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.