Heidi Marie Bruckert

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

8675-33 Issued in WI

Practice address

1300 E Green Bay St
Shawano, WI 54166-2210

Phone

(715) 201-0870

NPI assigned

May 30, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Specialty

Nurse Practitioner

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Green Bay Radiology SC 24 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Vincent Hospital Hospital, Green Bay, WI, CCN 520075

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Green Bay Radiology SC

  • Diagnostic Radiology Physician
  • Green Bay, WI
  • NPI 1447327986

  WI

  Medicare reassignment Care Compare group NPD
• GBR Sheboygan LLC

  • Diagnostic Radiology Physician
  • Sheboygan, WI
  • NPI 1467529917

  WI

  Medicare reassignment NPD
• St Clare Memorial Hospital, Inc

  • Critical Access Hospital
  • Oconto Falls, WI
  • NPI 1851477913

  WI

  Medicare reassignment NPD
• Prevea Clinic, Inc.

  • Internal Medicine Physician
  • Green Bay, WI
  • NPI 1306869276
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• St Vincent Hospital-Hospital Sisters-Third Order of St Francis

  • General Acute Care Hospital
  • Green Bay, WI
  • NPI 1114908001

  Hospital

  Care Compare affiliation
• St. Vincent Hospital-Hospital Sisters-Third Order of St Francis

  • Hematology & Oncology Physician
  • Sheboygan, WI
  • NPI 1831784636

  Hospital

  Care Compare affiliation
• St. Vincent Hospital-Hospital Sisters-Third Order of St. Francis

  • Hematology & Oncology Physician
  • Green Bay, WI
  • NPI 1184004236

  Hospital

  Care Compare affiliation
• St. Vincent Hospital-Hospital Sisters-Third Order of St. Francis

  • Hematology & Oncology Physician
  • Oconto Falls, WI
  • NPI 1750760740

  Hospital

  Care Compare affiliation
• St. Vincent Hospital-Hospital Sisters-Third Order of St. Francis

  • Hematology & Oncology Physician
  • Sturgeon Bay, WI
  • NPI 1760861751

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1527638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536796800000",
    "number": "1831681402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 E GREEN BAY ST",
            "city": "SHAWANO",
            "state": "WI",
            "postal_code": "541662210",
            "telephone_number": "920-496-4700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 E GREEN BAY ST",
            "city": "SHAWANO",
            "state": "WI",
            "postal_code": "541662210",
            "telephone_number": "715-201-0870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUCKERT",
        "first_name": "HEIDI",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-30",
        "last_updated": "2018-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WI",
            "license": "126356-30",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "8675-33",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janean Carol Brewington
• Corinne Bricco
• Bridge the Gap, Inc
• Brosnan Chiropractic, LLC
• Michael E Brosnan, DC
• Kelly Marie Bueschel, M.S., LPC
• Tracy L Burke, RN
• Linda L Burrack, RDH
• Patricia Harriet Busch, COTA
• Katie Bussian

• All providers in Shawano, WI
• Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2018; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.