1. Home
  2. Directory
  3. Wisconsin
  4. Waukesha
  5. Nurse Practitioner
  6. NPI Profile

SOPHIA N GUMINA
NPI 1568324325
Nurse Practitioner - Psychiatric/Mental Health in Waukesha, WI

Active since December 01, 2025PECOS Enrolled
309 E NORTH ST, WAUKESHA, WI 53188(262) 408-2530 Get Directions Write a Review

NPPES record last updated: May 15, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: May 15, 2026, Apr 20, 2026, Dec 1, 2025 (3 updates tracked since 2025).

About Sophia N Gumina NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOPHIA N GUMINA (NPI 1568324325) is an individual psychiatric/mental health provider in Waukesha, Wisconsin, licensed in Wisconsin (17601-33) and active in the NPI registry since December 2025. She is enrolled in Medicare PECOS, maintains 4 additional practice locations, and is a graduate of Other (2021).

NPPES Registry Identity

NPI1568324325
Entity TypeIndividualFemale
Primary Taxonomy363LP0808X
Provider Legal NameSOPHIA N GUMINA
Location Address309 E NORTH STWaukesha, WI 53188-3718
Mailing Address1032 S Cesar E Chavez DrMilwaukee, WI 53204-2203 · (414) 672-1353 · Fax (262) 408-5094
Phone(262) 408-2530
Sole ProprietorYes
Medical School CMSOtherGraduated 2021
Enumeration DateDecember 1, 2025
Last NPPES UpdateMay 15, 20263 updates tracked since enumeration
NPPES CertifiedMay 15, 2026
✔ NPI 1568324325 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
License✔ Licensed in WI · 17601-33
309 E NORTH ST, Waukesha, WI 53188
Open in Google Maps ↗

Secondary Practice Locations 4

Location 14570 S 27th StMilwaukee, WI 53221-2145 · Phone (414) 672-1353 · Fax (262) 408-5094
Location 21032 S Cesar E Chavez DrMilwaukee, WI 53204-2203 · Phone (414) 672-1353 · Fax (262) 408-5094
Location 31635 W National AveMilwaukee, WI 53204-1130 · Phone (414) 672-1353 · Fax (262) 408-5094
Location 42906 S 20th StMilwaukee, WI 53215-3732 · Phone (414) 672-1353 · Fax (262) 408-5094

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Dean Health Plan, Quartz.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Sophia N Gumina is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID1456822311
PECOS Enrollment IDI20260602002481
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Sophia Gumina reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

16th Street Community Health Center Inc.
0.2 mi
Federally Qualified Health Center (FQHC)
309 E NORTH ST
Waukesha, WI 53188
  • Reassigned Medicare billing, Wisconsin enrollment
  • 147 clinicians in this Medicare group
NPI 1144593815 (414) 672-1353

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 53188 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$82.92 typical visit price
range $53.90 – $163.24
Typical copayment $20.73 (range $13.47 – $40.81)
Most-billed visit code 99203
Established Patient
$95.41 typical visit price
range $17.40 – $133.76
Typical copayment $23.85 (range $4.35 – $33.44)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 10

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SIXTEENTH STREET COMMUNITY HEALTH CENTER INC.
Clinic/Center (Federally Qualified Health Center (FQHC))
309 E NORTH ST
WAUKESHA, WI 53188
Waukesha County (414) 672-1353
16TH STREET COMMUNITY HEALTH CENTER INC.
Clinic/Center (Federally Qualified Health Center (FQHC))
309 E NORTH ST
WAUKESHA, WI 53188
Waukesha County (414) 672-1353
NEIL MITCHELL LPC-IT
Counselor (Professional)
309 E NORTH ST
WAUKESHA, WI 53188
Waukesha County (262) 408-2530
THOMAS MCADAMS QTT
Counselor (Professional)
309 E NORTH ST
WAUKESHA, WI 53188
Waukesha County (414) 672-1353
LAWRENCE VERNON DULEK RADC I
Counselor (Addiction (Substance Use Disorder))
309 E NORTH ST
WAUKESHA, WI 53188
Waukesha County (414) 672-1353
MR. RICHARD H BROACH APNP
Clinical Nurse Specialist (Psychiatric/Mental Health, Adult)
309 E NORTH ST
WAUKESHA, WI 53188
Waukesha County (414) 672-1353
MS. PAULA C ORTEGA-JENNA LMFT
Marriage & Family Therapist
309 E NORTH ST
WAUKESHA, WI 53188
Waukesha County (414) 672-1353
KRISTINE SCARDINA LPC
Counselor (Professional)
309 E NORTH ST
WAUKESHA, WI 53188
Waukesha County (262) 408-2530

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Sophia Gumina's NPI number?

The NPI number for Sophia Gumina is 1568324325. It was assigned to this individual provider in the NPPES registry on December 1, 2025.

Where is Sophia Gumina located?

Sophia Gumina practices at 309 E North St, Waukesha, WI 53188. The listed phone number is (262) 408-2530.

What is Sophia Gumina's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Is Sophia Gumina enrolled in Medicare?

Yes. Sophia Gumina is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Sophia Gumina's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Sophia Gumina reassigns Medicare benefits to 16th Street Community Health Center Inc. (Waukesha, WI). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Sophia Gumina's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Sophia Gumina accept?

Health plans from Anthem Blue Cross and Blue Shield, Dean Health Plan and Quartz list Sophia Gumina as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Sophia Gumina was last updated on May 15, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.