Individual provider Active NPI

Vallikantha Nellaiappan, M.D

  • Endocrinology, Diabetes & Metabolism Physician
  • Greenfield, WI
National Provider Identifier
1548557812
Registry record updated Oct 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
101005 Issued in WI
Practice address
4448 W Loomis Rd
Greenfield, WI 53220-4800
Phone
(414) 281-5150
NPI assigned
Jul 6, 2011
Last updated
Oct 26, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2023

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 125059624 IL
Internal Medicine Physician 207R00000X 35.139412 OH
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 01077589A IN
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 35.139412 OH
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 101005 WI Primary

Addresses

Primary practice location

4448 W Loomis Rd
Greenfield, WI 53220-4800

Mailing address

PO Box 735044
Chicago, IL 60673-5044
Phone (414) 281-5150

Other practice location 1

3333 Green Bay Rd
North Chicago, IL 60064-3037
Phone (847) 578-3000

Other practice location 2

800 S Tillotson Ave
Muncie, IN 47304-4529
Phone (765) 289-5410

Other practice location 3

3691 Ridge Mill Dr
Hilliard, OH 43026-7752
Phone (614) 685-3333

Other identifiers 2

IdentifierTypeStateIssuer
100249522MedicaidWI
0418021MedicaidOH

Electronic endpoints 3

TypeEndpointUseAffiliation
Direct Messaging Address vnellaiappan902156@direct.osumc.edu
Direct Messaging Address vnellaiappan380833@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
I20230918002859 WI Practitioner - Endocrinology 8022250042 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Endocrinology
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Aurora Advanced Healthcare, Inc.Group PAC ID 3375625833, 1,107 clinicians
Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians
Lakeshore Medical Clinic LLCGroup PAC ID 7719890730, 375 clinicians

Practice addresses (Care Compare)

1055 N Mayfair Rd
Wauwatosa, WI 53226-3436
Phone (414) 476-8450

2801 W Kinnickinnic River Pkwy
Milwaukee, WI 53215-3669
Phone (414) 385-8600

4448 W Loomis Rd
Greenfield, WI 53220-4800
Phone (414) 281-5150

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35.139412OHMDEndocrinology, Diabetes & Metabolism Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeshore Medical Clinic, LLC CurrentSince Sep 25, 2023 Accepting new patients
Aurora Advanced Healthcare, Inc. Internal Medicine CurrentSince Sep 25, 2023 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Sep 25, 2023 Accepting new patients
Aurora Medical Group, Inc. Internal Medicine CurrentSince Sep 25, 2023 Accepting new patients
Aurora Advanced Healthcare Inc CurrentSince Sep 25, 2023 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

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

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

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

2801 W Kinnickinnic River Pkwy
Milwaukee, WI 53215
Phone (414) 384-5111

4448 W Loomis Rd
Milwaukee, WI 53220
Phone (414) 281-5150

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

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

1055 N Mayfair Rd
Wauwatosa, WI 53226
Phone (414) 476-8450

Interoperability endpoints

  • Direct secure messaging: vnellaiappan902156@direct.osumc.edu

Organizations & group practices 6

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 4

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": "1309910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698278400000",
    "number": "1548557812",
    "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": "414-281-5150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4448 W LOOMIS RD",
            "city": "GREENFIELD",
            "state": "WI",
            "postal_code": "532204800",
            "telephone_number": "414-281-5150"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3333 Green Bay Rd",
            "address_purpose": "LOCATION",
            "city": "North Chicago",
            "state": "IL",
            "postal_code": "600643037",
            "country_code": "US",
            "telephone_number": "847-578-3000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "800 S Tillotson Ave",
            "address_purpose": "LOCATION",
            "city": "Muncie",
            "state": "IN",
            "postal_code": "473044529",
            "country_code": "US",
            "telephone_number": "765-289-5410",
            "fax_number": "765-281-2085",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3691 Ridge Mill Dr",
            "address_purpose": "LOCATION",
            "city": "Hilliard",
            "state": "OH",
            "postal_code": "430267752",
            "country_code": "US",
            "telephone_number": "614-685-3333",
            "fax_number": "614-688-9220",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NELLAIAPPAN",
        "first_name": "VALLIKANTHA",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-06",
        "last_updated": "2023-10-26",
        "certification_date": "2023-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125059624",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35.139412",
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "IN",
            "license": "01077589A",
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "OH",
            "license": "35.139412",
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "WI",
            "license": "101005",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100249522",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0418021",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "vnellaiappan902156@direct.osumc.edu",
            "affiliation": "N",
            "address_1": "3691 Ridge Mill Dr",
            "city": "Hilliard",
            "state": "OH",
            "country_code": "US",
            "postal_code": "430267752",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "vnellaiappan380833@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "4448 W Loomis Rd",
            "city": "Greenfield",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532204800",
            "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": "4448 W Loomis Rd",
            "city": "Greenfield",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532204800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Greenfield, WI

Sources for this page

Verify at the official NPI Registry.