Active NPI
Andrea Maxwell, M.D.
- Pediatric Critical Care Medicine Physician
- Milwaukee, WI
National Provider Identifier
1770844672
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Critical Care Medicine Physician
- License
- 74747
- Practice address
- 9000 W Wisconsin Ave
Milwaukee, WI 53226-4874 - Phone
- (414) 266-3360
- Fax
- (414) 266-3563
- NPI assigned
- Jun 6, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Critical Care Medicine Physician | 2080P0203X | 74747 | WI | Primary |
Addresses
Primary practice location
9000 W Wisconsin Ave
Milwaukee, WI 53226-4874
Mailing address
9000 W Wisconsin Ave
Milwaukee, WI 53226-4874
Phone (414) 266-3360
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770844672 | Medicaid | WI |
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: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210421002971 | WI | Practitioner - Critical Care (Intensivists) | 9537466701 | Reassigns benefits to 2 organizations |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 74747 | WI | MD | Pediatric Critical Care Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Medical College of Wisconsin, Inc. | Internal Medicine | Current | Accepting new patients |
| Children'S Specialty Group, Inc. | Current | Accepting new patients |
Locations
8701 Watertown Plank Rd
Wauwatosa, WI 53226
Phone (414) 456-4100
9000 W Wisconsin Ave
Wauwatosa, WI 53226
Phone (414) 266-2625
Interoperability endpoints
- amaxwell89735@direct.chw.org
Organizations & group practices 2
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.
-
- Internal Medicine Physician
- Milwaukee, WI
- NPI 1699720086
Internal Medicine, WI
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1338940800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1625616000000",
"number": "1770844672",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9000 W WISCONSIN AVE",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532264874",
"telephone_number": "414-266-3360",
"fax_number": "414-266-3563"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9000 W WISCONSIN AVE",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532264874",
"telephone_number": "414-266-3360",
"fax_number": "414-266-3563"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAXWELL",
"first_name": "ANDREA",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-06-06",
"last_updated": "2021-07-07",
"certification_date": "2021-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "2080P0203X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Critical Care Medicine",
"state": "WI",
"license": "74747",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1770844672",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.