Gina M Suchocki
Individual provider Active NPI Nurse Practitioner · Crivitz, WI
NPI 1770018756 · NPPES record last updated Oct 4, 2023
Key facts
- NPI
- 1770018756
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 7658 (WI)
- Practice address
- 112 N US Highway 141
Crivitz, WI 54114-1708 - Phone
- (715) 854-3940
- Fax
- (715) 854-3941
- NPI assigned
- Apr 27, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Aurora Medical Group, Inc.
Practice addresses (Care Compare)
1020 N 12TH St
Milwaukee, WI 53233-1308
Phone (414) 219-3056
4061 Old Peshtigo Rd
Marinette, WI 54143-3887
Phone (715) 732-8000
Hospital & facility affiliations
- Aurora Medical Center Bay Area
- Aurora Baycare Medical Ctr
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 |
|---|---|---|---|---|
| I20170719003755 | WI | Practitioner - Nurse Practitioner | 0143590489 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7658-33 | WI | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aurora Medical Group, Inc. | Current | Accepting new patients | |
| Aurora Medical Group, Inc. | Current |
Accepting new patients | |
| Aurora Medical Group, Inc. | Current |
Accepting new patients | |
| Aurora Medical Group, Inc. | Past | Accepting new patients |
Locations
112 N US Highway 141
Crivitz, WI 54114
Phone (715) 735-6621
3003 University Dr
Marinette, WI 54143
Phone (715) 735-4200
4061 Old Peshtigo Rd
Marinette, WI 54143
Phone (715) 732-8000
3301 W Forest Home Ave
Milwaukee, WI 53215
Phone (414) 389-2233
1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056
Interoperability endpoints
- gsuchocki187210@direct.myadvocateaurora.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 7658-33 | WI | |
| Nurse Practitioner | 363L00000X | 7658 | WI | Yes |
Addresses
Primary practice location
112 N US Highway 141
Crivitz, WI 54114-1708
Mailing address
PO Box 735044
Chicago, IL 60673-5044
Phone (715) 854-3940
Other practice location 1
4061 Old Peshtigo Rd
Marinette, WI 54143-3887
Phone (715) 732-8000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100067621 | Medicaid | WI | |
| 473548414 | Other | WI | TAX ID FOR AURORA BAY AREA MEDICAL GROUP |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | gsuchocki187210@direct.myadvocateaurora.org | Direct | |
| FHIR URL | https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/ |
Other providers in Crivitz, WI
- Mary Elizabeth Rosner
- Kim A Rusch
- School District of Crivitz
- Deborah Ann Scriven
- Pawneet P Singh
- Joel A Supita
- Nathan M Tanney
- The Crivitz Rescue Squad, Inc
- Laura Toerck
- Twin Bridge Rescue Squad Inc
All providers in Crivitz, WI · 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 Oct 4, 2023. 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.