Individual provider Active NPI

Gregory Mark Heideman, M.D.

  • Diagnostic Radiology Physician
  • St Francis, WI
National Provider Identifier
1295820546
Registry record updated Apr 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
49522-020 Issued in WI
Practice address
2000 E Layton Ave
St Francis, WI 53235-6053
Phone
(414) 744-6589
NPI assigned
Oct 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2024

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 49522-020 WI Primary

Addresses

Primary practice location

2000 E Layton Ave
St Francis, WI 53235-6053

Mailing address

PO Box 735044
Chicago, IL 60673-5044
Phone (800) 326-2250

Other identifiers 1

IdentifierTypeStateIssuer
100008514MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address gheideman123682@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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100817001190 WI Practitioner - Diagnostic Radiology 6305970021 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Wisconsin School of Medicine, 2005
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

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

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

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

210 Wisconsin American Dr
Fond Du Lac, WI 54937-2999
Phone (920) 907-4800

215 W Washington St
Grafton, WI 53024-1700
Phone (262) 375-3700

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

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

2900 W Oklahoma Ave
Milwaukee, WI 53215-4330
Phone (414) 646-5410

3003 University Dr
Marinette, WI 54143-4110
Phone (715) 735-6621

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

36500 Aurora Dr
Summit, WI 53066-4899
Phone (262) 434-5000

5000 Memorial Dr
Two Rivers, WI 54241-3900
Phone (920) 794-5000

5900 S Lake Dr
Cudahy, WI 53110-3171
Phone (414) 489-9000

855 N Westhaven Dr
Oshkosh, WI 54904-7668
Phone (920) 303-8700

8901 W Lincoln Ave
West Allis, WI 53227-2409
Phone (414) 329-5930

945 N 12TH St
Milwaukee, WI 53233-1305
Phone (414) 219-7300

975 Port Washington Rd
Grafton, WI 53024-9204
Phone (262) 329-8650

W3985 County Rd NN
Elkhorn, WI 53121-4337
Phone (262) 741-2000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
49522-020WIMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Medical Group, Inc. CurrentSince Sep 29, 2014 Accepting new patients
Aurora Advanced Healthcare, Inc. CurrentSince Sep 27, 2014 Accepting new patients
Aurora Advanced Healthcare Inc CurrentSince Sep 27, 2014 Accepting new patients
Aurora Medical Group, Inc. Diagnostic Radiology Current Accepting new patients
Aurora Health Care Metro, Inc. CurrentSince Sep 29, 2014 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Sep 29, 2014 Accepting new patients
Aurora Health Care North, Inc. CurrentSince Aug 1, 2014 Accepting new patients
Aurora Health Care Metro, Inc. CurrentSince Sep 29, 2014 Accepting new patients
Lakeshore Medical Clinic, LLC CurrentSince Dec 14, 2014 Accepting new patients
The Medical College of Wisconsin, Inc. Past Accepting new patients

Locations

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

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

3003 University Dr
Marinette, WI 54143
Phone (715) 735-4200

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

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

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

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

2000 E Layton Ave
Ste 130
St Francis, WI 53235
Phone (414) 747-8856

5000 Memorial Dr
Two Rivers, WI 54241
Phone (920) 794-5000

4025 N 92nd St
Wauwatosa, WI 53222
Phone (414) 358-5431

Organizations & group practices 10

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 8

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": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711929600000",
    "number": "1295820546",
    "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",
            "telephone_number": "800-326-2250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 E LAYTON AVE",
            "city": "ST FRANCIS",
            "state": "WI",
            "postal_code": "532356053",
            "telephone_number": "414-744-6589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEIDEMAN",
        "first_name": "GREGORY",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2024-04-01",
        "certification_date": "2024-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WI",
            "license": "49522-020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100008514",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gheideman123682@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2900 W Oklahoma Ave",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532154330",
            "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": "2900 W Oklahoma Ave",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532154330",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in St Francis, WI

Sources for this page

Verify at the official NPI Registry.