Individual provider Active NPI

Bernadette Vitola, MD

  • Pediatric Gastroenterology Physician
  • Milwaukee, WI
National Provider Identifier
1962677310
Registry record updated Jan 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X
License
54845 Issued in WI
Practice address
9000 W Wisconsin Ave
Pediatric Gastroenterology
Milwaukee, WI 53226-4874
Phone
(414) 266-3690
Fax
(414) 266-3676
NPI assigned
Apr 28, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Transplant Hepatology Physician 2080T0004X 57.015938 OH
Pediatric Gastroenterology Physician 2080P0206X 54845 WI Primary

Addresses

Primary practice location

9000 W Wisconsin Ave
Pediatric Gastroenterology
Milwaukee, WI 53226-4874

Mailing address

9000 W Wisconsin Ave
Pediatric Gastroenterology
Milwaukee, WI 53226-4874
Phone (414) 266-3690

Other identifiers 1

IdentifierTypeStateIssuer
1962677310MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, DC2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20110117000143 WI Practitioner - GastroenterologyPractitioner - Pediatric Medicine 5092904466 Reassigns benefits to 2 organizations
I20211117000369 DC Practitioner - GastroenterologyPractitioner - Pediatric Medicine 5092904466 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
54845WIMDPediatric Gastroenterology Physician
57.015938OHMDPediatric Transplant Hepatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Children's Hospital Pediatrics CurrentSince Sep 27, 2021 Accepting new patients
MGMC, LLC Current Accepting new patients
Medstar Medical Group II LLC CurrentSince Sep 1, 2021 Accepting new patients
MGMC LLC CurrentSince Sep 1, 2021 Accepting new patients
Children's Specialty Group, Inc. Pediatrics CurrentSince Sep 4, 2024 Accepting new patients
The Medical College of Wisconsin, Inc. CurrentSince Sep 11, 2010 Accepting new patients
Children's Hospital CurrentSince Sep 27, 2021 Accepting new patients
Children's Hospital Current Accepting new patients

Locations

111 Michigan Ave NW
Washington, DC 20010
Phone (202) 476-3670

3800 Reservoir Rd NW
Washington, DC 20007
Phone (202) 687-2203

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

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

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

Organizations & group practices 8

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": "1209340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704672000000",
    "number": "1962677310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9000 W WISCONSIN AVE",
            "address_2": "PEDIATRIC GASTROENTEROLOGY",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532264874",
            "telephone_number": "414-266-3690",
            "fax_number": "414-266-3676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9000 W WISCONSIN AVE",
            "address_2": "PEDIATRIC GASTROENTEROLOGY",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532264874",
            "telephone_number": "414-266-3690",
            "fax_number": "414-266-3676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VITOLA",
        "first_name": "BERNADETTE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-28",
        "last_updated": "2024-01-08",
        "certification_date": "2024-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080T0004X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Transplant Hepatology",
            "state": "OH",
            "license": "57.015938",
            "primary": false
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "WI",
            "license": "54845",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1962677310",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.