Walter Drew Brandli, MSW, LCSW
Individual provider Active NPI Social Worker · Fond Du Lac, WI
NPI 1972608610 · NPPES record last updated Aug 3, 2022
Key facts
- NPI
- 1972608610
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- 1063 (WI)
- Practice address
- 430 E Division St
Fond Du Lac, WI 54935-4560 - Phone
- (920) 926-4200
- Fax
- (920) 926-8885
- NPI assigned
- Sep 14, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 17
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 1987
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Agnesian Healthcare Inc
Practice addresses (Care Compare)
430 E Division St
Fond Du Lac, WI 54935-4560
Phone (920) 929-2300
Hospital & facility affiliations
- SSM Health St Agnes Hospital-Fond Du Lac
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100629000964 | WI | Practitioner - Clinical Social Worker | 7416088745 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Arts
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Agnesian Healthcare Inc | Current |
Accepting new patients | |
| Agnesian Healthcare, Inc | Current |
Accepting new patients |
Locations
430 E Division St
Fond du Lac, WI 54935
Phone (920) 926-4200
420 E Division St
Fond du Lac, WI 54935
Phone (920) 923-7400
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 1063 | WI | Yes |
| Clinical Social Worker | 1041C0700X | 1063 | WI |
Addresses
Primary practice location
430 E Division St
Fond Du Lac, WI 54935-4560
Mailing address
430 E Division St
Fond Du Lac, WI 54935-4560
Phone (920) 926-4200
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12840 | Other | WI | DEAN HEALTH |
| 39619800 | Medicaid | WI |
Other names
- Drew Brandli
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | wbrandli332555@direct-ehr-ssmhc.com | Direct | |
| FHIR URL | https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ | Other |
Other providers in Fond Du Lac, WI
- Margaret Miller Boyd
- Billie J Braatz
- Jessica M Braatz
- Ann Michelle Bradley
- Angela Brahm
- Darrell Brands
- Tammy Brant
- Jessica Braskamp
- Andrew Braun
- Lindsey Braun
All providers in Fond Du Lac, WI · Social Worker in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 3, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.