Individual provider Active NPI

Nicolette Deveneau

  • Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician
  • Milwaukee, WI
National Provider Identifier
1982877866
Registry record updated Sep 25, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urogynecology and Reconstructive Pelvic Surgery (Urology) PhysicianTaxonomy code 2088F0040X
License
54414 Issued in WI
Practice address
2350 N Lake Dr
Suite 504
Milwaukee, WI 53211-4528
Phone
(414) 289-9668
Fax
(414) 289-0974
NPI assigned
Apr 11, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X TP KY
Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician 2088F0040X 54414 WI Primary

Addresses

Primary practice location

2350 N Lake Dr
Suite 504
Milwaukee, WI 53211-4528

Mailing address

4425 N Port Washington Rd
Glendale, WI 53212-1082
Phone (414) 326-2218

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150727002802 WI Practitioner - UrologyPractitioner - Obstetrics/Gynecology 4880857853 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
UrologyAlso: Obstetrics/Gynecology
Education
University of Texas Medical School at San Antonio, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Madison Medical Affiliates IncGroup PAC ID 5991606337, 86 clinicians

Practice addresses (Care Compare)

2350 N Lake Dr
Suite 501
Milwaukee, WI 53211-4528
Phone (414) 298-7171

Hospital & facility affiliations

  • Ascension Columbia St Marys Hospital Milwaukee Hospital, Milwaukee, WI, CCN 520051
  • Ascension SE Wisconsin Hospital Hospital, Milwaukee, WI, CCN 520136

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of the uterus1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Madison Medical Affiliates, Inc. CurrentSince May 1, 2022 Accepting new patients
Columbia St. Mary'S Hospital Milwaukee, Inc CurrentSince Aug 1, 2015 Accepting new patients
Columbia St. Mary'S Hospital Milwaukee Inc CurrentSince Aug 1, 2015 Accepting new patients
The University Gynecological & Obstetrical Foundation, Inc. Past Accepting new patients

Locations

7423 Solutions Ctr
Chicago, IL 60677

788 N Jefferson St
Ste 300
Milwaukee, WI 53202
Phone (414) 272-8950

2350 N Lake Dr
Ste 504
Milwaukee, WI 53211
Phone (414) 289-9668

788 N Jefferson St
Ste 401
Milwaukee, WI 53202
Phone (414) 226-4020

2350 N Lake Dr
Ste 501
Milwaukee, WI 53211
Phone (414) 226-4020

2350 N Lake Dr
Ste 305
Milwaukee, WI 53211
Phone (414) 298-7171

801 S 70th St
West Allis, WI 53214
Phone (414) 773-6600

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/11299/brand/1/csg/1/fhir/r4

Organizations & group practices 4

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.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1207872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1443139200000",
    "number": "1982877866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4425 N PORT WASHINGTON RD",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532121082",
            "telephone_number": "414-326-2218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2350 N LAKE DR",
            "address_2": "SUITE 504",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532114528",
            "telephone_number": "414-289-9668",
            "fax_number": "414-289-0974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEVENEAU",
        "first_name": "NICOLETTE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-11",
        "last_updated": "2015-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "KY",
            "license": "TP",
            "primary": false
        },
        {
            "code": "2088F0040X",
            "taxonomy_group": "",
            "desc": "Urology, Urogynecology and Reconstructive Pelvic Surgery",
            "state": "WI",
            "license": "54414",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.