Individual provider Active NPI

Nancy Blankenship, M.D.

  • Diagnostic Radiology Physician
  • New Berlin, WI
National Provider Identifier
1104840636
Registry record updated Nov 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
27558 Issued in WI
Practice address
2875 S 171St St
New Berlin, WI 53151-3511
Phone
(262) 786-3107
Fax
(262) 780-0442
NPI assigned
Jul 27, 2006
Last updated
Nov 23, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 27558 WI Primary

Addresses

Primary practice location

2875 S 171St St
New Berlin, WI 53151-3511

Mailing address

2875 S 171St St
New Berlin, WI 53151-3511
Phone (262) 786-3107

Other identifiers 1

IdentifierTypeStateIssuer
31581000MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/
Direct Messaging Address nblankenship13328@direct.myadvocateaurora.org Direct

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
I20050112000575 WI Practitioner - Diagnostic Radiology 4789632175 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Medical College of Wisconsin, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians
Aurora Advanced Healthcare, Inc.Group PAC ID 3375625833, 1,107 clinicians
Lakeshore Medical Clinic LLCGroup PAC ID 7719890730, 375 clinicians

Practice addresses (Care Compare)

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

1032 E Sumner St
Hartford, WI 53027-1608
Phone (262) 673-2300

10400 75TH St
Kenosha, WI 53142-7884
Phone (262) 948-7000

1055 N Mayfair Rd
Wauwatosa, WI 53226-3436
Phone (414) 476-8450

1136 Westowne Dr
Neenah, WI 54956-2175
Phone (920) 456-2030

12203 N Corporate Pkwy
Mequon, WI 53092-3388
Phone (262) 387-8200

12500 Aurora Dr
Pleasant Prairie, WI 53158-1227
Phone (262) 857-5000

13250 Washington Ave
Mount Pleasant, WI 53177-1516
Phone (262) 884-4000

14555 W National Ave
Suite 120
New Berlin, WI 53151-4494
Phone (262) 827-2955

146 E Geneva SQ
Lake Geneva, WI 53147-9694
Phone (262) 249-5000

1475 W Grand Ave
Port Washington, WI 53074-2074
Phone (262) 268-5100

1640 E Sumner St
Hartford, WI 53027-2684
Phone (262) 670-4000

2000 E Layton Ave
Saint Francis, WI 53235-6053
Phone (414) 744-6589

201 E Morrissey Dr
Elkhorn, WI 53121-4395
Phone (262) 723-3100

205 Valley Ave
West Bend, WI 53095-5312
Phone (262) 338-1123

2414 Kohler Memorial Dr
Sheboygan, WI 53081-3129
Phone (920) 457-4461

2424 S 90TH St
Suite 306
West Allis, WI 53227-2455
Phone (414) 328-8750

248 McHenry St
Burlington, WI 53105-1828
Phone (262) 767-8000

252 McHenry St
Burlington, WI 53105-1828
Phone (262) 767-7000

2600 Kiley Way
Plymouth, WI 53073-5020
Phone (920) 449-7000

2801 W Kinnickinnic River Pkwy
Suite 345
Milwaukee, WI 53215-3669
Phone (414) 649-7900

2999 N Mayfair Rd
Suite 100
Wauwatosa, WI 53222-4306
Phone (414) 479-7000

3003 W Good Hope Rd
Milwaukee, WI 53209-2042
Phone (414) 352-3100

3289 N Mayfair Rd
Wauwatosa, WI 53222-3203
Phone (414) 771-7900

3400 Union Ave
Sheboygan, WI 53081-8426
Phone (920) 828-2530

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
27558WIMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeshore Medical Clinic, LLC CurrentSince Dec 14, 2014 Accepting new patients
Aurora Advanced Healthcare, Inc. CurrentSince May 10, 2011 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Jan 1, 2009 Accepting new patients
Aurora Medical Group, Inc. Diagnostic Radiology Current Accepting new patients
Aurora Advanced Healthcare Inc CurrentSince May 10, 2011 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Jan 1, 2009 Accepting new patients
Aurora Health Care Metro, Inc. CurrentSince Jun 23, 2018 Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients
Great Lakes Radiologists SC Diagnostic Radiology Past Accepting new patients

Locations (25 of 34)

252 McHenry St
Burlington, WI 53105
Phone (262) 763-2411

112 N US Highway 141
Crivitz, WI 54114
Phone (715) 735-6621

W3985 Highway NN
Elkhorn, WI 53121
Phone (262) 741-2000

12500 W Bluemound Rd
Elm Grove, WI 53122
Phone (262) 780-3434

210 Wisconsin American Dr
Fond du Lac, WI 54937
Phone (920) 907-7000

3003 W Good Hope Rd
Glendale, WI 53209
Phone (414) 352-3100

7080 N Port Washington Rd
Glendale, WI 53217
Phone (414) 228-4940

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

1004 E Sumner St
Hartford, WI 53027
Phone (262) 670-7000

1032 E Sumner St
Hartford, WI 53027
Phone (262) 670-4300

10117 74th St
Ste 110
Kenosha, WI 53142
Phone (262) 697-1919

7550 22nd Ave
Kenosha, WI 53143
Phone (262) 658-2500

601 Reed Ave
Manitowoc, WI 54220
Phone (920) 682-8841

3003 University Dr
Marinette, WI 54143
Phone (715) 735-3187

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

12203 N Corporate Pkwy
Mequon, WI 53092
Phone (262) 387-8200

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

1575 N Rivercenter Dr
Milwaukee, WI 53212
Phone (414) 283-8444

2900 W Oklahoma Ave
Milwaukee, WI 53215
Phone (414) 385-2590

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

945 N 12th St
Milwaukee, WI 53233
Phone (414) 219-5800

8400 Washington Ave
Mount Pleasant, WI 53406
Phone (262) 231-3000

225 Eagle Lake Ave
Mukwonago, WI 53149
Phone (262) 363-3360

S74W16775 Janesville Rd
Muskego, WI 53150
Phone (414) 422-4747

620 Warren St
Redgranite, WI 54970
Phone (920) 566-0620

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637625600000",
    "number": "1104840636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2875 S 171ST ST",
            "city": "NEW BERLIN",
            "state": "WI",
            "postal_code": "531513511",
            "telephone_number": "262-786-3107",
            "fax_number": "262-780-0442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2875 S 171ST ST",
            "city": "NEW BERLIN",
            "state": "WI",
            "postal_code": "531513511",
            "telephone_number": "262-786-3107",
            "fax_number": "262-780-0442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLANKENSHIP",
        "first_name": "NANCY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-27",
        "last_updated": "2021-11-23",
        "certification_date": "2021-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WI",
            "license": "27558",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31581000",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "2875 S 171st St",
            "city": "New Berlin",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531513511",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nblankenship13328@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2875 S 171st St",
            "city": "New Berlin",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531513511",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in New Berlin, WI

Sources for this page

Verify at the official NPI Registry.