Individual provider Active NPI

Kelly Scudder, APNP

  • Nurse Practitioner
  • West Allis, WI
National Provider Identifier
1871154138
Registry record updated Nov 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
11041-33 Issued in WI
Practice address
2424 S 90TH St
West Allis, WI 53227-2455
Phone
(414) 328-8700
NPI assigned
Jun 26, 2019
Last updated
Nov 21, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 11041-33 WI Primary

Addresses

Primary practice location

2424 S 90TH St
West Allis, WI 53227-2455

Mailing address

PO Box 735044
Chicago, IL 60673-5044
Phone (800) 326-2250

Other practice location 1

1265 W American Dr Ste 100
Neenah, WI 54956-1405
Phone (920) 886-8979

Other identifiers 1

IdentifierTypeStateIssuer
100191808MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address kscudder392526@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
I20220216000924 WI Practitioner - Nurse Practitioner 6103153077 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Duke University School of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians

Practice addresses (Care Compare)

2424 S 90TH St
West Allis, WI 53227-2455
Phone (414) 328-8630

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11041-33WIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St Luke's Methodist Hospital Current Accepting new patients
Aurora Medical Group, Inc. CurrentSince Jun 29, 2024 Accepting new patients
Aurora Medical Group, Inc. Current Accepting new patients
Wisconsin Institute of Urology SC CurrentSince Feb 27, 2023 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Jun 29, 2024 Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients

Locations

1506 S Oneida St
Fl 5
Appleton, WI 54915
Phone (920) 730-4950

1726 Shawano Ave
Green Bay, WI 54303
Phone (920) 432-6016

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

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

1265 West American Dr
#100
Neenah, WI 54956
Phone (920) 722-7747

2700 W 9th Ave
Oshkosh, WI 54904
Phone (920) 223-0220

600 N Westhaven Dr
Oshkosh, WI 54904
Phone (920) 237-5000

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

2424 S 90th St
Ste 300
West Allis, WI 53227
Phone (414) 328-8150

Interoperability endpoints

  • Direct secure messaging: kmcdowell671587@direct.unitypoint.org
  • Direct secure messaging: kscudder392526@direct.myadvocateaurora.org

Organizations & group practices 6

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": "1561507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732147200000",
    "number": "1871154138",
    "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",
            "telephone_number": "800-326-2250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2424 S 90TH ST",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532272455",
            "telephone_number": "414-328-8700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1265 W American Dr Ste 100",
            "address_purpose": "LOCATION",
            "city": "Neenah",
            "state": "WI",
            "postal_code": "549561405",
            "country_code": "US",
            "telephone_number": "920-886-8979",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SCUDDER",
        "first_name": "KELLY",
        "credential": "APNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-26",
        "last_updated": "2024-11-21",
        "certification_date": "2024-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "11041-33",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100191808",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kscudder392526@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2424 S 90th St",
            "city": "West Allis",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532272455",
            "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 St",
            "city": "West Allis",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532272455",
            "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.