Individual provider Active NPI

Elliot Frederick Thieleke, CRNA

  • Certified Registered Nurse Anesthetist
  • Milwaukee, WI
National Provider Identifier
1134859564
Registry record updated Jul 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
13054 Issued in WI
Practice address
900 N 92ND St
Milwaukee, WI 53226-1202
Phone
(414) 805-3000
NPI assigned
Jun 17, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 13054 WI Primary

Addresses

Primary practice location

900 N 92ND St
Milwaukee, WI 53226-1202

Mailing address

155 Washington St Apt 510
Jersey City, NJ 07302-4576
Phone (920) 946-3331

Other identifiers 1

IdentifierTypeStateIssuer
100212120MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221005000085 WI Practitioner - Certified Registered Nurse Anesthetist (Crna) 9739565383 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Medical College of Wisconsin IncGroup PAC ID 2668384371, 2,092 clinicians

Practice addresses (Care Compare)

8701 W Watertown Plank
Milwaukee, WI 53226-3548
Phone (414) 805-3666

8701 Watertown Plank Rd
Room 4041 MFRC
Milwaukee, WI 53226-3548
Phone (414) 805-3666

Hospital & facility affiliations

  • Froedtert Memorial Lutheran Hospital Hospital, Milwaukee, WI, CCN 520177

Merit-based Incentive Payment System (MIPS)

Final score
87.99 of 100Reported as group
Quality
82.81
Promoting interoperability
100
Improvement activities
40
Cost
77.15

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
13054WIMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
The Medical College of Wisconsin, Inc. CurrentSince Jul 1, 2024 Accepting new patients

Locations

9200 W Wisconsin Ave
Wauwatosa, WI 53226
Phone (414) 259-3000

8701 Watertown Plank Rd
Wauwatosa, WI 53226
Phone (414) 456-4100

Organizations & group practices 1

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": "1655424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721865600000",
    "number": "1134859564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 WASHINGTON ST APT 510",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073024576",
            "telephone_number": "920-946-3331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 N 92ND ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532261202",
            "telephone_number": "414-805-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THIELEKE",
        "first_name": "ELLIOT",
        "middle_name": "FREDERICK",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-17",
        "last_updated": "2024-07-25",
        "certification_date": "2024-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "WI",
            "license": "13054",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100212120",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.