Lindsey Jo Provenzano Burgess – Physician Assistant

Key facts

NPI: 1992137012
Entity type: Individual (NPI type 1)
Primary specialty: Physician Assistant 363A00000X
License: 3195 (WI)
Practice address: 201 E Morrissey Dr
Elkhorn, WI 53121-4395
Phone: (262) 723-6666
NPI assigned: Jul 31, 2013
Sex: Female
Sole proprietor: No

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.

Ascension Medical Group-Southeast Wisconsin Inc Internal Medicine Physician · Glendale, WI · NPI 1609881077

Medicare reassignment Care Compare group NPD PHYSICIAN ASSISTANT · WI
Columbia St. Mary'S Hospital Milwaukee, Inc Multi-Specialty Clinic/Center · Milwaukee, WI · NPI 1023064482

Medicare reassignment WI

Hospital & facility affiliations 1

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

Ascension All Saints Hospital, Inc General Acute Care Hospital · Racine, WI · NPI 1639123284

Care Compare affiliation Hospital

Medicare Care Compare profile

Specialty: Physician Assistant
Education: Other, 2013
Medicare assignment: Accepts the Medicare-approved amount as payment in full
Group practices: Ascension Medical Group-Southeast Wisconsin Inc (551 clinicians)

Practice addresses (Care Compare)

13950 W Capitol Dr
Brookfield, WI 53005-2441
Phone (414) 302-5400

3801 Spring St
Mount Pleasant, WI 53405-1667
Phone (262) 687-4011

3803 Spring St
Mount Pleasant, WI 53405-1660

3807 Spring St
Mount Pleasant, WI 53405-1667
Phone (262) 687-8300

3809 Spring St
Mount Pleasant, WI 53405-1667
Phone (262) 687-5000

3811 Spring St
Mount Pleasant, WI 53405-1667

3821 Spring St
Mount Pleasant, WI 53405-1667
Phone (262) 687-8460

Hospital & facility affiliations

Ascension All Saints Hospital Hospital · Racine, WI · CCN 520096

Medicare participation

Medicare fee-for-service enrollment: Enrolled in WI
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20131028000919	WI	Practitioner - Physician Assistant	4385879428	Reassigns benefits to 2 organizations

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Physician Assistant

State licenses

License	State	Type	Specialty
3195	WI	MD	Physician Assistant

Practice roles

Organization	Specialty	Status	New patients
Ascension Medical Group-Southeast Wisconsin Inc	Physician Assistant	Current since Jan 25, 2024	Accepting new patients

Locations

13950 W Capitol Dr
Brookfield, WI 53005
Phone (414) 302-5400

2301 N Lake Dr
Milwaukee, WI 53211
Phone (414) 270-4932

3811 Spring St
#201
Mount Pleasant, WI 53405
Phone (262) 687-5850

201 N Mayfair Rd
Fl 2
Wauwatosa, WI 53226
Phone (414) 771-8228

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Physician Assistant	363A00000X	3195	WI	Yes

Addresses

Primary practice location

201 E Morrissey Dr
Elkhorn, WI 53121-4395

Mailing address

201 E Morrissey Dr
Elkhorn, WI 53121-4395
Phone (262) 723-6666

Other names

Lindsey Jo Provenzano Former name

Other providers in Elkhorn, WI

All providers in Elkhorn, WI · Physician Assistant in Wisconsin

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 12, 2017. 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.

Verify at the official NPI Registry.