Individual provider Active NPI

Brian Christofferson, PA-C

  • Physician Assistant
  • Milwaukee, WI
National Provider Identifier
1770522948
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1153-023 Issued in WI
Practice address
8901 N 76TH St
Milwaukee, WI 53223-1901
Phone
(414) 354-0772
Fax
(414) 365-0773
NPI assigned
Jun 5, 2006
Last updated
Jul 13, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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 1153-023 WI Primary

Addresses

Primary practice location

8901 N 76TH St
Milwaukee, WI 53223-1901

Mailing address

8901 N 76TH St
Milwaukee, WI 53223-1901
Phone (414) 354-0772

Other identifiers 1

IdentifierTypeStateIssuer
42988900MedicaidWI

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
I20100806000450 WI Practitioner - Physician Assistant 6800929167 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1153-023WIMDPhysician Assistant

Organizations & group practices 1

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1770522948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8901 N 76TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532231901",
            "telephone_number": "414-354-0772",
            "fax_number": "414-365-0773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8901 N 76TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532231901",
            "telephone_number": "414-354-0772",
            "fax_number": "414-365-0773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHRISTOFFERSON",
        "first_name": "BRIAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-05",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "1153-023",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42988900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.