Individual provider Active NPI

Tracey L Dovi, APNP

  • Nurse Practitioner
  • Milwaukee, WI
National Provider Identifier
1417120825
Registry record updated Dec 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
3407 Issued in WI
Practice address
2801 W Kinnickinnic River Pkwy
Suite 840
Milwaukee, WI 53215-3669
Phone
(414) 649-3530
Fax
(414) 649-3529
NPI assigned
Apr 7, 2008
Last updated
Dec 1, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 3407 WI Primary
Adult Health Nurse Practitioner 363LA2200X 3407-33 WI

Addresses

Primary practice location

2801 W Kinnickinnic River Pkwy
Suite 840
Milwaukee, WI 53215-3669

Mailing address

2801 W Kinnickinnic River Pkwy
Suite 840
Milwaukee, WI 53215-3669
Phone (414) 649-3530

Other identifiers 1

IdentifierTypeStateIssuer
36061700MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address tdovi15380@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
I20110720000109 WI Practitioner - Nurse Practitioner 8224117460 Reassigns benefits to 2 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
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

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

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3407WIMDNurse Practitioner
3407-33WIMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeshore Medical Clinic, LLC CurrentSince Mar 1, 2020 Accepting new patients
Aurora Medical Group, Inc. CurrentSince May 24, 2011 Accepting new patients
Aurora Medical Group, Inc. Current Accepting new patients
Aurora Medical Group, Inc. CurrentSince May 24, 2011 Accepting new patients
Midwest Area Physicians, LLC Past Accepting new patients
Comprehensive Cardiovascular Care, LLP Past Accepting new patients
Cardiovascular Associates of Wisconsin, LLP Past Accepting new patients

Locations

1905 E Huebbe Pkwy
Beloit, WI 53511
Phone (608) 364-2293

5900 S Lake Dr
Cudahy, WI 53110
Phone (414) 489-4055

12500 W Bluemound Rd
Elm Grove, WI 53122
Phone (262) 780-3434

7080 N Port Washington Rd
Glendale, WI 53217
Phone (414) 228-4940

123 N Military Ave
Green Bay, WI 54303
Phone (920) 494-3421

2733 S Ridge Rd
Green Bay, WI 54304
Phone (920) 497-6200

2845 Greenbrier Rd
#1
Green Bay, WI 54311
Phone (920) 288-8100

10117 74th St
Ste 110
Kenosha, WI 53142
Phone (262) 697-1919

6308 8th Ave
Kenosha, WI 53143
Phone (262) 653-5300

601 Reed Ave
Manitowoc, WI 54220
Phone (920) 682-8841

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

2801 W Kinnickinnic River Pkwy
Ste 840
Milwaukee, WI 53215
Phone (414) 649-3776

5017 S 110th St
Milwaukee, WI 53228
Phone (414) 427-8282

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

915 Summit Ave
Summit, WI 53066
Phone (262) 569-2300

W231N1440 Corporate Ct
Waukesha, WI 53186
Phone (262) 896-6000

205 Valley Ave
West Bend, WI 53095
Phone (262) 338-1123

Organizations & group practices 7

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": "1207526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638316800000",
    "number": "1417120825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 W KINNICKINNIC RIVER PKWY",
            "address_2": "SUITE 840",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532153669",
            "telephone_number": "414-649-3530",
            "fax_number": "414-649-3529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 W KINNICKINNIC RIVER PKWY",
            "address_2": "SUITE 840",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532153669",
            "telephone_number": "414-649-3530",
            "fax_number": "414-649-3529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOVI",
        "first_name": "TRACEY",
        "middle_name": "L",
        "credential": "APNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-07",
        "last_updated": "2021-12-01",
        "certification_date": "2021-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "3407",
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "WI",
            "license": "3407-33",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36061700",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tdovi15380@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2801 W Kinnickinnic River Pkwy",
            "address_2": "Suite 840",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532153669",
            "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": "2801 W Kinnickinnic River Pkwy",
            "address_2": "Suite 840",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532153669",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.