NPIMap

Individual provider Active NPI

Ivy E Leasum, NP

  • Family Nurse Practitioner
  • De Pere, WI
National Provider Identifier
1295925824
Registry record updated Apr 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
3141-33 Issued in WI
Practice address
320 N Wisconsin St
De Pere, WI 54115-2737
Phone
(920) 327-7056
NPI assigned
Jul 30, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 3141-33 WI Primary

Addresses

Primary practice location

320 N Wisconsin St
De Pere, WI 54115-2737

Mailing address

320 N Wisconsin St
De Pere, WI 54115-2737
Phone (920) 327-7056

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ileasum5472@ewd.direct.hshs.org Direct St Vincent Hospital-Hospital Sisters-Third Order of St Francis

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
I20070831000178 WI Practitioner - Nurse Practitioner 7012000383 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2502 S Ashland Ave
Green Bay, WI 54304-5252
Phone (920) 496-4700

Hospital & facility affiliations

  • St Vincent Hospital Hospital, Green Bay, WI, CCN 520075

Merit-based Incentive Payment System (MIPS)

Final score
94.81 of 100Reported as apm
Quality
85.98
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
3141WIMDPhysical Therapy Assistant
3141-33WIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St. Clare Memorial Hospital, Inc. CurrentSince Jan 13, 2024 Accepting new patients
St Nicholas Hospital-Sisters of the Third Order of St Francis CurrentSince Jan 13, 2024 Accepting new patients
St. Nicholas Hospital-Sisters of the Third Order of St Francis Current Accepting new patients
Prevea Clinic, Inc. CurrentSince Jan 13, 2024 Accepting new patients
Prevea Clinic, Inc. CurrentSince Jan 13, 2024 Accepting new patients
St Nicholas Hospital-Sisters of the Third Order of St Francis Family CurrentSince Jan 13, 2024 Accepting new patients

Locations

720 S Van Buren St
Ste 301
Green Bay, WI 54301
Phone (920) 433-9000

2502 S Ashland Ave
Green Bay, WI 54304
Phone (920) 496-4750

835 S Van Buren St
Green Bay, WI 54301
Phone (888) 901-7246

1726 Shawano Ave
Green Bay, WI 54303
Phone (920) 432-6016

835 S Main St
Oconto Falls, WI 54154
Phone (920) 846-0509

855 S Main St
Ste 1
Oconto Falls, WI 54154
Phone (920) 846-8187

3100 Superior Ave
Sheboygan, WI 53081
Phone (800) 472-6710

Organizations & group practices 8

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 5

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": "1185753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713744000000",
    "number": "1295925824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 N WISCONSIN ST",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541152737",
            "telephone_number": "920-327-7056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 N WISCONSIN ST",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541152737",
            "telephone_number": "920-327-7056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEASUM",
        "first_name": "IVY",
        "middle_name": "E",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-30",
        "last_updated": "2024-04-22",
        "certification_date": "2024-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "3141-33",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ileasum5472@ewd.direct.hshs.org",
            "affiliation": "Y",
            "affiliationName": "St Vincent Hospital-Hospital Sisters-Third Order of St Francis",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "2502 S Ashland Ave",
            "city": "Green Bay",
            "state": "WI",
            "country_code": "US",
            "postal_code": "543045252",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in De Pere, WI

Sources for this page

Verify at the official NPI Registry.