NPIMap

Individual provider Active NPI

Katherine Rose Anderson, PA-C

  • Physician Assistant
  • West Allis, WI
National Provider Identifier
1780059394
Registry record updated Nov 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
3687-23 Issued in WI
Practice address
2424 S 90TH Street
Suite 500
West Allis, WI 53227-7030
Phone
(414) 321-2255
Fax
(414) 321-2091
NPI assigned
Dec 8, 2015
Last updated
Nov 19, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2021

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 3687-23 WI Primary

Addresses

Primary practice location

2424 S 90TH Street
Suite 500
West Allis, WI 53227-7030

Mailing address

2424 S 90TH Street
Suite 500
West Allis, WI 53227-7030
Phone (414) 321-2255

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address kwarren171285@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
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160223000652 WI Practitioner - Physician Assistant 8628373099 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians
Aurora Advanced Healthcare, Inc.Group PAC ID 3375625833, 1,107 clinicians

Practice addresses (Care Compare)

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

12203 N Corporate Pkwy
Mequon, WI 53092-3388
Phone (262) 387-8200

2424 S 90TH St
Suite 306
West Allis, WI 53227-2455
Phone (414) 328-8750

2999 N Mayfair Rd
Suite 100
Wauwatosa, WI 53222-4306
Phone (414) 479-7000

8901 W Lincoln Ave
West Allis, WI 53227-2409
Phone (414) 329-5950

9000 W Sura LN
Greenfield, WI 53228-3477
Phone (414) 246-6800

945 N 12TH St
Milwaukee, WI 53233-1305
Phone (414) 219-2000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3687-23WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Advanced Healthcare, Inc. CurrentSince Jan 23, 2016 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Aug 20, 2017 Accepting new patients
Aurora Advanced Healthcare Inc CurrentSince Jan 23, 2016 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Aug 20, 2017 Accepting new patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. Past Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients
Lifetime OB GYN, LTD. 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

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

2424 S 90th St
Ste 500
West Allis, WI 53227
Phone (414) 321-2255

Organizations & group practices 8

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.

Hospital & facility affiliations 4

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": "1449532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637280000000",
    "number": "1780059394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2424 S 90TH STREET",
            "address_2": "SUITE 500",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532277030",
            "telephone_number": "414-321-2255",
            "fax_number": "414-321-2091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2424 S 90TH STREET",
            "address_2": "SUITE 500",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532277030",
            "telephone_number": "414-321-2255",
            "fax_number": "414-321-2091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "KATHERINE",
        "middle_name": "ROSE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-12-08",
        "last_updated": "2021-11-19",
        "certification_date": "2021-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "3687-23",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kwarren171285@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2424 S 90th Street",
            "address_2": "Suite 500",
            "city": "West Allis",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532277030",
            "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": "2424 S 90th Street",
            "address_2": "Suite 500",
            "city": "West Allis",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532277030",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in West Allis, WI

Sources for this page

Verify at the official NPI Registry.