Individual provider Active NPI

Lian H Mleziva, PA

  • Physician Assistant
  • Menomonee Falls, WI
National Provider Identifier
1588189229
Registry record updated Jun 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
4131-23 Issued in WI
Practice address
W180N8085 Town Hall Rd
Menomonee Falls, WI 53051-3518
Phone
(262) 257-5100
Fax
(262) 253-7081
NPI assigned
Aug 3, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 4131-23 WI Primary

Addresses

Primary practice location

W180N8085 Town Hall Rd
Menomonee Falls, WI 53051-3518

Mailing address

W180N8085 Town Hall Rd
Menomonee Falls, WI 53051-3518
Phone (262) 257-5100

Other practice location 1

3200 Pleasant Valley Rd
West Bend, WI 53095-9274
Phone (262) 836-7200

Other identifiers 1

IdentifierTypeStateIssuer
1588189229MedicaidWI

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
I20170824002929 WI Practitioner - Physician Assistant 1557633567 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
87.99 of 100Reported as group
Quality
82.81
Promoting interoperability
100
Improvement activities
40
Cost
77.15

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
4131-23WIMDPhysician Assistant

Organizations & group practices 1

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1501718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622678400000",
    "number": "1588189229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W180N8085 TOWN HALL RD",
            "city": "MENOMONEE FALLS",
            "state": "WI",
            "postal_code": "530513518",
            "telephone_number": "262-257-5100",
            "fax_number": "262-253-7081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W180N8085 TOWN HALL RD",
            "city": "MENOMONEE FALLS",
            "state": "WI",
            "postal_code": "530513518",
            "telephone_number": "262-257-5100",
            "fax_number": "262-253-7081"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3200 Pleasant Valley Rd",
            "address_purpose": "LOCATION",
            "city": "West Bend",
            "state": "WI",
            "postal_code": "530959274",
            "country_code": "US",
            "telephone_number": "262-836-7200",
            "fax_number": "262-836-7201",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MLEZIVA",
        "first_name": "LIAN",
        "middle_name": "H",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-03",
        "last_updated": "2021-06-03",
        "certification_date": "2021-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "4131-23",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1588189229",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Menomonee Falls, WI

Sources for this page

Verify at the official NPI Registry.