Individual provider Active NPI

Christine Bengtson

  • Pediatric Nurse Practitioner
  • Wauwatosa, WI
National Provider Identifier
1922575349
Registry record updated Jun 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
8807-33 Issued in WI
Practice address
9000 W Wisconsin Ave
Wauwatosa, WI 53226-4874
Phone
(414) 266-2860
Fax
(414) 266-6749
NPI assigned
Oct 24, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Registered Nurse 163WP0200X 225846-30 WI
Pediatric Nurse Practitioner 363LP0200X 8807-33 WI Primary

Addresses

Primary practice location

9000 W Wisconsin Ave
Wauwatosa, WI 53226-4874

Mailing address

9000 W Wisconsin Ave
Wauwatosa, WI 53226-4874
Phone (414) 266-2860

Other identifiers 1

IdentifierTypeStateIssuer
1922575349MedicaidWI

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
I20181211001502 WI Practitioner - Nurse Practitioner 9537403027 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
225846-30WIMDPediatric Registered Nurse
8807-33WIMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The Medical College of Wisconsin, Inc. CurrentSince Oct 27, 2018 Accepting new patients
Children's Specialty Group, Inc. CurrentSince Mar 10, 2024 Accepting new patients

Locations

8701 Watertown Plank Rd
Wauwatosa, WI 53226
Phone (414) 456-4100

9000 W Wisconsin Ave
Ste B440
Wauwatosa, WI 53226
Phone (414) 266-6840

9000 W Wisconsin Ave
Wauwatosa, WI 53226
Phone (414) 266-2625

Interoperability endpoints

  • Direct secure messaging: cbengtson39325@direct.chw.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": "1540339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622851200000",
    "number": "1922575349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9000 W WISCONSIN AVE",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532264874",
            "telephone_number": "414-266-2860",
            "fax_number": "414-266-6749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9000 W WISCONSIN AVE",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532264874",
            "telephone_number": "414-266-2860",
            "fax_number": "414-266-6749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENGTSON",
        "first_name": "CHRISTINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-24",
        "last_updated": "2021-06-05",
        "certification_date": "2021-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Pediatrics",
            "state": "WI",
            "license": "225846-30",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "WI",
            "license": "8807-33",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1922575349",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wauwatosa, WI

Sources for this page

Verify at the official NPI Registry.