Individual provider Active NPI

Anthony A Niezyniecki, M.D.

  • Emergency Medicine Physician
  • Milwaukee, WI
National Provider Identifier
1104864842
Registry record updated Jan 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
38776-020 Issued in WI
Practice address
111 E Wisconsin Ave
Milwaukee, WI 53202-4815
Phone
(414) 290-6720
Fax
(414) 290-6755
NPI assigned
Jun 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2009

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 036-094801 IL
Emergency Medicine Physician 207P00000X 38776-020 WI Primary

Addresses

Primary practice location

111 E Wisconsin Ave
Milwaukee, WI 53202-4815

Mailing address

111 E Wisconsin Ave
Milwaukee, WI 53202-4815
Phone (414) 290-6720

Other identifiers 6

IdentifierTypeStateIssuer
930068408OtherWIMEDICARE RAILROAD
930063876OtherWIMEDICARE RAILROAD
930062816OtherILMEDICARE RAILROAD
32353600MedicaidWI
P00036018OtherWIMEDICARE RAILROAD
P00079203OtherILMEDICARE RAILROAD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20060421000399 IL Practitioner - Emergency Medicine 7719997642 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Northwestern University Feinberg Medical School, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rockford Emergency Physicians, LLCGroup PAC ID 4385007640, 51 clinicians
Belvidere Emergency Physicians, LLCGroup PAC ID 1254794415, 23 clinicians

Practice addresses (Care Compare)

1401 E State St
Rockford, IL 61104-2315
Phone (779) 696-4400

1625 S State St
Belvidere, IL 61008-5907
Phone (815) 547-5441

Hospital & facility affiliations

  • Uw Health Hospital, Rockford, IL, CCN 140228

Merit-based Incentive Payment System (MIPS)

Final score
86.3 of 100Reported as group
Quality
78.11
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-094801ILMDEmergency Medicine Physician
38776-020WIMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Belvidere Emergency Physicians, LLC Emergency Medicine CurrentSince Aug 15, 2023 Accepting new patients
Rockford Emergency Physicians, LLC Emergency Medicine CurrentSince Aug 15, 2023 Accepting new patients
Health Dynamics, LLC Past Accepting new patients
Ihc-Libertyville Emergency Physicians, LLC Emergency Medicine Past Accepting new patients
United Occupational Medicine and Walk in Services, LLC Emergency Medicine Past Accepting new patients

Locations

1625 S State St
Belvidere, IL 61008
Phone (815) 544-1846

1401 E State St
Rockford, IL 61104
Phone (815) 489-4267

Organizations & group practices 5

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 1

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": "1149292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1233273600000",
    "number": "1104864842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 E WISCONSIN AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532024815",
            "telephone_number": "414-290-6720",
            "fax_number": "414-290-6755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 E WISCONSIN AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532024815",
            "telephone_number": "414-290-6720",
            "fax_number": "414-290-6755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIEZYNIECKI",
        "first_name": "ANTHONY",
        "middle_name": "A",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-03",
        "last_updated": "2009-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036-094801",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WI",
            "license": "38776-020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "930068408",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "930063876",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "930062816",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32353600",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00036018",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00079203",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.