NPIMap

Individual provider Active NPI

Nicholas James Heezen, D.O.

  • Internal Medicine Physician
  • Green Bay, WI
National Provider Identifier
1114227857
Registry record updated Dec 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
57651 Issued in WI
Practice address
2253 W Mason St
Suite 200
Green Bay, WI 54303-4706
Phone
(920) 327-7300
NPI assigned
Oct 28, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 11, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 57651 WI Primary

Addresses

Primary practice location

2253 W Mason St
Suite 200
Green Bay, WI 54303-4706

Mailing address

PO Box 73544
Chicago, IL 60673-7544

Other identifiers 1

IdentifierTypeStateIssuer
100027340MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address nheezen60090@direct.myadvocateaurora.org Direct
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
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121016000517 WI Practitioner - Internal Medicine 7315197993 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
At Still University, Arizona School of Dentistry & Oral HLTH, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians

Practice addresses (Care Compare)

2253 W Mason St
Green Bay, WI 54303-4706
Phone (920) 327-7300

Hospital & facility affiliations

  • Aurora at Home Home health agency, Green Bay, WI, CCN 527302
  • Unity Hospice Hospice, De Pere, WI, CCN 521503
  • Aurora Baycare Medical Ctr Hospital, Green Bay, WI, CCN 520193
  • Aurora Medical Center Bay Area Hospital, Marinette, WI, CCN 520113

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
57651WIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Medical Group, Inc. CurrentSince Oct 8, 2012 Accepting new patients
Aurora Medical Group, Inc. Internal Medicine CurrentSince Oct 8, 2012 Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients
Baycare Aurora, LLC Past Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients

Locations

123 N Military Ave
Green Bay, WI 54303
Phone (920) 494-3421

2253 W Mason St
#200
Green Bay, WI 54303
Phone (920) 327-7300

2253 W Mason St
Ste 200
Green Bay, WI 54303
Phone (920) 327-7300

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

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

Interoperability endpoints

  • Direct secure messaging: nheezen60090@direct.myadvocateaurora.org

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 6

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": "1288224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702252800000",
    "number": "1114227857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 73544",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606737544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2253 W MASON ST",
            "address_2": "SUITE 200",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543034706",
            "telephone_number": "920-327-7300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEEZEN",
        "first_name": "NICHOLAS",
        "middle_name": "JAMES",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-10-28",
        "last_updated": "2023-12-11",
        "certification_date": "2023-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "57651",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100027340",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nheezen60090@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2253 W Mason St",
            "address_2": "Suite 200",
            "city": "Green Bay",
            "state": "WI",
            "country_code": "US",
            "postal_code": "543034706",
            "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": "2253 W Mason St",
            "address_2": "Suite 200",
            "city": "Green Bay",
            "state": "WI",
            "country_code": "US",
            "postal_code": "543034706",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.