NPIMap

Individual provider Active NPI

Paige Brockdorf, DNP, APRN, FNP-BC

  • Family Nurse Practitioner
  • Appleton, WI
National Provider Identifier
1790457638
Registry record updated Mar 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
11108-33 Issued in WI
Practice address
5320 W Michaels Dr
Appleton, WI 54913-8446
Phone
(920) 882-8200
Fax
(920) 882-8210
NPI assigned
Sep 29, 2021
Last updated
Mar 3, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 11108-33 WI Primary

Addresses

Primary practice location

5320 W Michaels Dr
Appleton, WI 54913-8446

Mailing address

5320 W Michaels Dr
Appleton, WI 54913-8446
Phone (920) 882-8200

Other names 1

  • Paige Domurat Former name

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
I20211115000635 WI Practitioner - Nurse Practitioner 6305235243 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
Group practices
Neurospine Center of Wisconsin, S.C.Group PAC ID 1153217740, 21 clinicians

Practice addresses (Care Compare)

5320 W Michaels Dr
Appleton, WI 54913-8446
Phone (920) 882-8200

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
70.83 of 100Reported as group
Quality
48.15
Promoting interoperability
100
Improvement activities
40
Cost
54.62

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
11108-33WIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Neurospine Center of Wisconsin, S.C. CurrentSince Nov 6, 2023 Accepting new patients

Locations

5320 W Michaels Dr
Grand Chute, WI 54913
Phone (920) 735-7650

130 2nd St
Neenah, WI 54956
Phone (920) 729-2063

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1632873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740960000000",
    "number": "1790457638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5320 W MICHAELS DR",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549138446",
            "telephone_number": "920-882-8200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5320 W MICHAELS DR",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549138446",
            "telephone_number": "920-882-8200",
            "fax_number": "920-882-8210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROCKDORF",
        "first_name": "PAIGE",
        "credential": "DNP, APRN, FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-29",
        "last_updated": "2025-03-03",
        "certification_date": "2025-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "11108-33",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PAIGE",
            "last_name": "DOMURAT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Appleton, WI

Sources for this page

Verify at the official NPI Registry.