Individual provider Active NPI

Christine B Kamelle, PA

  • Physician Assistant
  • Milwaukee, WI
National Provider Identifier
1821090440
Registry record updated Oct 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2252 Issued in WI
Practice address
2801 W KK River Parkway
Suite 245
Milwaukee, WI 53215
Phone
(414) 649-6780
Fax
(414) 649-6030
NPI assigned
Aug 12, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2023

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 2252 WI Primary

Addresses

Primary practice location

2801 W KK River Parkway
Suite 245
Milwaukee, WI 53215

Mailing address

PO Box 735044
Chicago, IL 60673-5044

Other identifiers 3

IdentifierTypeStateIssuer
100000719MedicaidWI
1821090440MedicaidWI
739750881OtherWIMEDICARE PROVIDER

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address ckamelle24684@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: 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
I20081125000750 WI Practitioner - Physician Assistant 0840198321 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
001386CTMDMarriage & Family Therapist
2252WIMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Medical Group, Inc. CurrentSince Oct 13, 2008 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Oct 13, 2008 Accepting new patients

Locations

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

2801 W Kinnickinnic River Pkwy
Ste 245
Milwaukee, WI 53215
Phone (414) 649-6421

Interoperability endpoints

  • Direct secure messaging: ckamelle24684@direct.myadvocateaurora.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.

NPI Registry JSON

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

{
    "created_epoch": "1123804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698019200000",
    "number": "1821090440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 735044",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606735044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 W KK RIVER PARKWAY",
            "address_2": "SUITE 245",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "53215",
            "telephone_number": "414-649-6780",
            "fax_number": "414-649-6030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAMELLE",
        "first_name": "CHRISTINE",
        "middle_name": "B",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-12",
        "last_updated": "2023-10-23",
        "certification_date": "2023-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "2252",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100000719",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1821090440",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER",
            "identifier": "739750881",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ckamelle24684@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2801 W KK River Parkway",
            "address_2": "Suite 245",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "53215",
            "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": "2801 W KK River Parkway",
            "address_2": "Suite 245",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "53215",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.