Individual provider Active NPI

Angela K Gleisner, PA-C

  • Physician Assistant
  • Mount Pleasant, WI
National Provider Identifier
1154636447
Registry record updated Nov 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2583-23 Issued in WI
Practice address
8400 Washington Ave
Mount Pleasant, WI 53406-3735
Phone
(262) 884-4088
NPI assigned
Aug 11, 2010
Last updated
Nov 30, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2583-23 WI Primary

Addresses

Primary practice location

8400 Washington Ave
Mount Pleasant, WI 53406-3735

Mailing address

PO Box 735044
Chicago, IL 60673-5044

Other practice location 1

10625 W North Ave
Suite 102
Milwaukee, WI 53226-2315
Phone (414) 877-5350

Other identifiers 2

IdentifierTypeStateIssuer
100010915MedicaidWI
2853-23OtherWIWI LICENSE

Other names 1

  • Angela K Grelk Former name

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address agleisner341024@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: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110208000335 WI Practitioner - Physician Assistant 2163602111 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
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)

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

2621 S Green Bay Rd
Racine, WI 53406-4948
Phone (262) 504-6100

8400 Washington Ave
Mount Pleasant, WI 53406-3735
Phone (262) 321-3000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2583-23WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeshore Medical Clinic, LLC CurrentSince Jun 5, 2022 Accepting new patients
Aurora Advanced Healthcare, Inc. CurrentSince Jun 5, 2022 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Jun 5, 2022 Accepting new patients
Aurora Advanced Healthcare Inc CurrentSince Jun 5, 2022 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Jun 5, 2022 Accepting new patients
Integrated Therapeutic Massage LLC PastSince Aug 1, 2021 Accepting new patients
Racine Emergency Physicians, S.C. Past Accepting new patients

Locations

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

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

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

3237 S 16th St
Milwaukee, WI 53215
Phone (414) 647-5000

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

5000 W Chambers St
Milwaukee, WI 53210
Phone (414) 447-2089

3801 Spring St
Mount Pleasant, WI 53405
Phone (262) 636-4011

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

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

2000 E Layton Ave
St Francis, WI 53235
Phone (414) 744-7880

201 N Mayfair Rd
Fl 2
Wauwatosa, WI 53226
Phone (414) 771-8228

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": "1281484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701302400000",
    "number": "1154636447",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8400 WASHINGTON AVE",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "534063735",
            "telephone_number": "262-884-4088"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10625 W North Ave",
            "address_2": "Suite 102",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532262315",
            "country_code": "US",
            "telephone_number": "414-877-5350",
            "fax_number": "414-877-5360",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GLEISNER",
        "first_name": "ANGELA",
        "middle_name": "K",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-11",
        "last_updated": "2023-11-30",
        "certification_date": "2023-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "2583-23",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100010915",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WI LICENSE",
            "identifier": "2853-23",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "agleisner341024@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "8400 Washington Ave",
            "city": "Mount Pleasant",
            "state": "WI",
            "country_code": "US",
            "postal_code": "534063735",
            "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": "8400 Washington Ave",
            "city": "Mount Pleasant",
            "state": "WI",
            "country_code": "US",
            "postal_code": "534063735",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "ANGELA",
            "last_name": "GRELK",
            "middle_name": "K",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Mount Pleasant, WI

Sources for this page

Verify at the official NPI Registry.