Active NPI
Bluestone Physician Services Wisconsin SC
- Family Medicine Physician
- Milwaukee, WI
National Provider Identifier
1922497908
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- BLUESTONE PHYSICIAN SERVICES WISCONSIN SC
- Practice address
- 342 N Water St Ste 600
Milwaukee, WI 53202-5715 - Phone
- (651) 342-1039
- Fax
- (651) 342-1428
- NPI assigned
- Jan 14, 2015
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Brandon Clark
- Title
- Ceo
- Phone
- (480) 518-1333
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
342 N Water St Ste 600
Milwaukee, WI 53202-5715
Mailing address
270 Main St N Ste 300
Stillwater, MN 55082-6788
Phone (651) 342-1039
Other names 1
- Bluestone
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20151014003197 | WI | Part B Supplier - Clinic/Group Practice | 7719296789 |
Receives reassigned benefits from 32 practitioners Practice locations: Milwaukee, WI |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 52D2195082 | Bluestone Physician Services Wisconsin, SC | Certificate of waiver | Oct 5, 2026 |
National Provider Directory
National Provider DirectoryLocations
2302 E Glenhurst Ln
Appleton, WI 54913
Phone (920) 574-2401
210 McDivitt Ln
Mukwonago, WI 53149
Practitioners & affiliated clinicians
Practitioners 32
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Adult Health Nurse Practitioner
- Milwaukee, WI
- NPI 1558594184
WI
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1421193600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1786060800000",
"number": "1922497908",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "270 MAIN ST N STE 300",
"city": "STILLWATER",
"state": "MN",
"postal_code": "550826788",
"telephone_number": "651-342-1039",
"fax_number": "651-342-1428"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "342 N WATER ST STE 600",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532025715",
"telephone_number": "651-342-1039",
"fax_number": "651-342-1428"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BLUESTONE PHYSICIAN SERVICES WISCONSIN SC",
"organizational_subpart": "NO",
"enumeration_date": "2015-01-14",
"last_updated": "2026-08-07",
"certification_date": "2026-08-07",
"status": "A",
"authorized_official_last_name": "CLARK",
"authorized_official_first_name": "BRANDON",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "480-518-1333"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Bluestone",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- 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.