NPIMap

Individual provider Active NPI

Chadbourne Walters, APNP

  • Nurse Practitioner
  • Appleton, WI
National Provider Identifier
1801482294
Registry record updated Sep 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
10333-33 Issued in WI
Practice address
2105 E Enterprise Ave
Ste 111
Appleton, WI 54913-7862
Phone
(920) 731-6611
Fax
(920) 731-6732
NPI assigned
Dec 19, 2020
Last updated
Sep 14, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 10333-33 WI Primary
Family Nurse Practitioner 363LF0000X 10333 WI

Addresses

Primary practice location

2105 E Enterprise Ave
Ste 111
Appleton, WI 54913-7862

Mailing address

2105 E Enterprise Ave
Ste 111
Appleton, WI 54913-7862

Other identifiers 2

IdentifierTypeStateIssuer
187532-30OtherWIWISCONSIN DEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES (REGISTERED NURSE)
10333-33OtherWIWISCONSIN DEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES (ADVANCED PRACTICE NURS

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
I20210125000724 WI Practitioner - Nurse Practitioner 4587078076 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ascension NE Wisconsin, IncGroup PAC ID 7719897784, 19 clinicians

Practice addresses (Care Compare)

1506 S Oneida St
Appleton, WI 54915-1305
Phone (920) 738-2000

835 S Van Buren St
Green Bay, WI 54301-3526
Phone (920) 433-0111

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
10333-33WIMDNurse Practitioner
10333WIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St. Vincent Hospital-Hospital Sisters-Third Order of St. Francis CurrentSince May 1, 2023 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis CurrentSince May 1, 2023 Accepting new patients
Ascension NE Wisconsin, Inc Current Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis Nurse Practitioner Current Accepting new patients
Ascension NE Wisconsin, Inc CurrentSince Jun 28, 2023 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis Past Accepting new patients
Aspirus Rhinelander & Tomahawk Hospitals & Clinics, Inc. Past Accepting new patients
Ascension Medical Group-Fox Valley Wisconsin, Inc PastSince May 1, 2021 Accepting new patients

Locations

1506 S Oneida St
Appleton, WI 54915
Phone (920) 730-4950

835 S Van Buren St
Green Bay, WI 54301
Phone (888) 901-7246

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 7

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": "1608336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631577600000",
    "number": "1801482294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2105 E ENTERPRISE AVE",
            "address_2": "STE 111",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549137862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2105 E ENTERPRISE AVE",
            "address_2": "STE 111",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549137862",
            "telephone_number": "920-731-6611",
            "fax_number": "920-731-6732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTERS",
        "first_name": "CHADBOURNE",
        "credential": "APNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-12-19",
        "last_updated": "2021-09-14",
        "certification_date": "2021-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "10333-33",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "10333",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WISCONSIN DEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES (REGISTERED NURSE)",
            "identifier": "187532-30",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WISCONSIN DEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES (ADVANCED PRACTICE NURS",
            "identifier": "10333-33",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

Verify at the official NPI Registry.