NPIMap

Individual provider Active NPI

Matthew Brian Kowalke, MD

  • Internal Medicine Physician
  • Marinette, WI
National Provider Identifier
1932605425
Registry record updated Dec 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
21645 Issued in WI
Practice address
4061 Old Peshtigo Rd
Marinette, WI 54143-3887
Phone
(715) 732-8000
NPI assigned
Apr 3, 2018
Last updated
Dec 26, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 149932 FL
Internal Medicine Physician 207R00000X ME149932 FL
Internal Medicine Physician 207R00000X 21645 WI Primary

Addresses

Primary practice location

4061 Old Peshtigo Rd
Marinette, WI 54143-3887

Mailing address

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

Other practice location 1

7915 US Highway 301 N Ste 107
Ellenton, FL 34222-3532
Phone (941) 847-1101

Other identifiers 1

IdentifierTypeStateIssuer
100189732MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address mkowalke327836@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
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211230000527 WI Practitioner - Internal Medicine 9537417316 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2018
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)

4061 Old Peshtigo Rd
Marinette, WI 54143-3887
Phone (715) 732-8000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
149932FLMDInternal Medicine Physician
21645WIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Medical Group, Inc. CurrentSince Dec 17, 2021 Accepting new patients
Aurora Medical Group, Inc. Internal Medicine Current Accepting new patients
Aurora Medical Group, Inc. CurrentSince Dec 17, 2021 Accepting new patients
Florida Medical Specialists LLC Internal Medicine Past Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients

Locations

4061 Old Peshtigo Rd
Marinette, WI 54143
Phone (715) 732-8000

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

3301 W Forest Home Ave
Milwaukee, WI 53215
Phone (414) 389-2233

Organizations & group practices 5

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 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1522713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735171200000",
    "number": "1932605425",
    "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": "4061 OLD PESHTIGO RD",
            "city": "MARINETTE",
            "state": "WI",
            "postal_code": "541433887",
            "telephone_number": "715-732-8000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7915 US Highway 301 N Ste 107",
            "address_purpose": "LOCATION",
            "city": "Ellenton",
            "state": "FL",
            "postal_code": "342223532",
            "country_code": "US",
            "telephone_number": "941-847-1101",
            "fax_number": "941-417-2811",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOWALKE",
        "first_name": "MATTHEW",
        "middle_name": "BRIAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-03",
        "last_updated": "2024-12-26",
        "certification_date": "2024-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "149932",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME149932",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "21645",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100189732",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mkowalke327836@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "4061 Old Peshtigo Rd",
            "city": "Marinette",
            "state": "WI",
            "country_code": "US",
            "postal_code": "541433887",
            "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": "4061 Old Peshtigo Rd",
            "city": "Marinette",
            "state": "WI",
            "country_code": "US",
            "postal_code": "541433887",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Marinette, WI

Sources for this page

Verify at the official NPI Registry.