Individual provider Active NPI

Marissa Le, M.D.

  • Otolaryngology Physician
  • Elkhorn, WI
National Provider Identifier
1326369901
Registry record updated Sep 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
63961 Issued in WI
Practice address
201 E Morrissy Dr
Elkhorn, WI 53121-4395
Phone
(262) 723-3100
NPI assigned
Jun 17, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 125-058062 IL
Otolaryngology Physician 207Y00000X 63961 WI Primary

Addresses

Primary practice location

201 E Morrissy Dr
Elkhorn, WI 53121-4395

Mailing address

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

Other practice location 1

1653 W Congress Pkwy
Chicago, IL 60612-3833
Phone (312) 942-6303

Other identifiers 1

IdentifierTypeStateIssuer
100047991MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address mle155957@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
I20150911000617 WI Practitioner - Otolaryngology 3870800626 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Rush Medical College of Rush University, 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)

201 E Morrissey Dr
Elkhorn, WI 53121-4395
Phone (262) 723-3100

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125-058062ILMDOtolaryngology Physician
63961WIMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Medical Group, Inc. CurrentSince Sep 14, 2015 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Sep 14, 2015 Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients

Locations

201 E Morrissy Dr
Elkhorn, WI 53121
Phone (262) 723-3100

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

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

Interoperability endpoints

  • Direct secure messaging: mle155957@direct.myadvocateaurora.org

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.

Hospital & facility affiliations 2

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": "1276732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725840000000",
    "number": "1326369901",
    "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": "201 E MORRISSY DR",
            "city": "ELKHORN",
            "state": "WI",
            "postal_code": "531214395",
            "telephone_number": "262-723-3100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1653 W Congress Pkwy",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606123833",
            "country_code": "US",
            "telephone_number": "312-942-6303",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LE",
        "first_name": "MARISSA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-17",
        "last_updated": "2024-09-09",
        "certification_date": "2024-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "IL",
            "license": "125-058062",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "WI",
            "license": "63961",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100047991",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mle155957@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "201 E Morrissy Dr",
            "city": "Elkhorn",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531214395",
            "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": "201 E Morrissy Dr",
            "city": "Elkhorn",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531214395",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Elkhorn, WI

Sources for this page

Verify at the official NPI Registry.