Individual provider Active NPI

Leah A Nitke, DO

  • Internal Medicine Physician
  • Green Bay, WI
National Provider Identifier
1053428417
Registry record updated Jun 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
47005 Issued in WI
Practice address
2845 Greenbrier Rd
#130
Green Bay, WI 54308-8900
Phone
(920) 288-8100
Fax
(920) 288-8152
NPI assigned
Aug 23, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 47005 WI Primary
Internal Medicine Physician 207R00000X 36109515 IL

Addresses

Primary practice location

2845 Greenbrier Rd
#130
Green Bay, WI 54308-8900

Mailing address

PO Box 735044
Chicago, IL 60673-5044
Phone (800) 326-2250

Other identifiers 1

IdentifierTypeStateIssuer
43515600MedicaidWI

Other names 1

  • Leah Ann Kornowski Former name

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address lnitke57629@direct.myadvocateaurora.org
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

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
I20040726000784 WI Practitioner - Internal Medicine 2961482211 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians

Practice addresses (Care Compare)

1020 N 12TH St
Milwaukee, WI 53233-1308
Phone (414) 219-3056

1160 Kepler Dr
Green Bay, WI 54311-8321
Phone (920) 288-5500

1565 Allouez Ave
Green Bay, WI 54311-5639
Phone (920) 468-2400

1910 Alabama St
Sturgeon Bay, WI 54235-3532
Phone (920) 746-7200

2845 Greenbrier Rd
Green Bay, WI 54311-6519
Phone (920) 288-8100

2890 Lineville Rd
Green Bay, WI 54313-7202
Phone (920) 662-2100

4061 Old Peshtigo Rd
Marinette, WI 54143-3887
Phone (715) 732-8000

4070 Equestrian LN
Green Bay, WI 54229-9649
Phone (920) 866-6100

629 Solvang Way
Denmark, WI 54208-8951
Phone (920) 863-2600

Hospital & facility affiliations

  • Aurora at Home Home health agency, Green Bay, WI, CCN 527302
  • Unity Hospice Hospice, De Pere, WI, CCN 521503
  • Moments Hospice of Green Bay Hospice, Green Bay, WI, CCN 521619
  • Aurora Baycare Medical Ctr Hospital, Green Bay, WI, CCN 520193

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
36109515ILMDInternal Medicine Physician
47005WIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Baycare Aurora, LLC CurrentSince Apr 12, 2010 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Jul 1, 2004 Accepting new patients
Aurora Medical Group, Inc. Internal Medicine CurrentSince Jul 1, 2004 Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients

Locations

2253 W Mason St
Green Bay, WI 54303
Phone (920) 327-7000

2733 S Ridge Rd
Green Bay, WI 54304
Phone (920) 497-6200

2845 Greenbrier Rd
Green Bay, WI 54311
Phone (920) 288-3388

2845 Greenbrier Rd
#1
Green Bay, WI 54311
Phone (920) 288-8100

2845 Greenbrier Rd
#130
Green Bay, WI 54311
Phone (920) 288-8100

2845 Greenbrier Rd
Ste 120
Green Bay, WI 54311
Phone (920) 288-8100

3301 W Forest Home Ave
Milwaukee, WI 53215
Phone (414) 389-2233

1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056

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 4

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": "1156291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718668800000",
    "number": "1053428417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 735044",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606735044",
            "telephone_number": "800-326-2250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2845 GREENBRIER RD",
            "address_2": "#130",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543088900",
            "telephone_number": "920-288-8100",
            "fax_number": "920-288-8152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NITKE",
        "first_name": "LEAH",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-23",
        "last_updated": "2024-06-18",
        "certification_date": "2024-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "47005",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "36109515",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43515600",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lnitke57629@direct.myadvocateaurora.org",
            "affiliation": "N",
            "address_1": "2845 Greenbrier Rd",
            "address_2": "#130",
            "city": "Green Bay",
            "state": "WI",
            "country_code": "US",
            "postal_code": "543088900",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "2845 Greenbrier Rd",
            "address_2": "#130",
            "city": "Green Bay",
            "state": "WI",
            "country_code": "US",
            "postal_code": "543088900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "LEAH",
            "last_name": "KORNOWSKI",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.