Individual provider Active NPI

Heather J. Wade Newell, MD

  • Pediatrics Physician
  • Green Bay, WI
National Provider Identifier
1326194903
Registry record updated Sep 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
67831 Issued in WI
Practice address
1160 Kepler Dr
Green Bay, WI 54311-8321
Phone
(920) 288-5500
NPI assigned
Jan 26, 2007
Last updated
Sep 22, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X MD60281972 WA
Pediatrics Physician 208000000X 52113 MN
Pediatrics Physician 208000000X 67831 WI Primary

Addresses

Primary practice location

1160 Kepler Dr
Green Bay, WI 54311-8321

Mailing address

PO Box 735044
Chicago, IL 60673-5044
Phone (920) 288-5500

Other practice location 1

12720 Bass Lake Rd
Maple Grove, MN 55369-6307
Phone (763) 559-2861

Other identifiers 2

IdentifierTypeStateIssuer
1326194903MedicaidMN
100071383MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address hwadenewell192423@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
I20171011001089 WI Practitioner - Pediatric Medicine 7012163868 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD60281972WAMDPediatrics Physician
67831WIMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Medical Group, Inc. CurrentSince Oct 16, 2017 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Oct 16, 2017 Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients

Locations

1160 Kepler Dr
Green Bay, WI 54311
Phone (920) 288-5400

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

Organizations & group practices 3

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": "1169769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695340800000",
    "number": "1326194903",
    "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": "920-288-5500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1160 KEPLER DR",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543118321",
            "telephone_number": "920-288-5500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12720 Bass Lake Rd",
            "address_purpose": "LOCATION",
            "city": "Maple Grove",
            "state": "MN",
            "postal_code": "553696307",
            "country_code": "US",
            "telephone_number": "763-559-2861",
            "fax_number": "763-559-1338",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WADE NEWELL",
        "first_name": "HEATHER",
        "middle_name": "J.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-26",
        "last_updated": "2023-09-22",
        "certification_date": "2023-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "MD60281972",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "52113",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WI",
            "license": "67831",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1326194903",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100071383",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hwadenewell192423@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1160 Kepler Dr",
            "city": "Green Bay",
            "state": "WI",
            "country_code": "US",
            "postal_code": "543118321",
            "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": "1160 Kepler Dr",
            "city": "Green Bay",
            "state": "WI",
            "country_code": "US",
            "postal_code": "543118321",
            "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.