Active NPI
Elizabeth A Nietert, MD
- Dermatology Physician
- Springfield, IL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 036-130434
- Practice address
- 751 N Rutledge St
Suite 2300
Springfield, IL 62702-4968 - Phone
- (217) 545-3821
- Fax
- (217) 545-4485
- NPI assigned
- May 3, 2007
- Last updated
- Aug 16, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 54439-020 | WI | |
| Dermatology Physician | 207N00000X | 036-130434 | IL | Primary |
Addresses
Primary practice location
751 N Rutledge St
Suite 2300
Springfield, IL 62702-4968
Mailing address
PO Box 19644
Springfield, IL 62794-9644
Phone (217) 545-8000
Other practice location 1
10500 W Loomis Rd Ste 110
Franklin, WI 53132-8030
Phone (262) 898-4400
Other practice location 2
510 N 17TH Ave Ste C
Wausau, WI 54401-4281
Phone (715) 849-5333
Other practice location 3
33 Green Bay Rd
Sturgeon Bay, WI 54235-2831
Phone (920) 746-4434
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036130434 | Medicaid | IL | |
| 1619199072 | Medicaid | WI | |
| 171400024 | Other | WI | MEDICARE |
| 54439-020 | Other | WI | STATE LICENSE |
Electronic endpoints 3
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | Elizabeth.Nietert@forefrontdermatology.emadirect.md | ||
| Direct Messaging Address | Elizabeth.Nietert@forefrontdermatology.emadirect.md | ||
| Direct Messaging Address | Elizabeth.Nietert@forefrontdermatology.emadirect.md |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI, IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Dermatology
- Education
- Medical College of Wisconsin, 2006
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
510 N 17TH Ave
Suite C
Wausau, WI 54401-4281
Phone (715) 849-5333
751 N Rutledge St
Springfield, IL 62702-4968
Phone (217) 545-8000
Hospital & facility affiliations
Merit-based Incentive Payment System (MIPS)
- Final score
- 75 of 100
Merit-based Incentive Payment System (MIPS)
- Final score
- 97.45 of 100
- Promoting interoperability
- 97
- Improvement activities
- 40
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Melanoma (skin cancer) excision | 1-10 |
| Removal of skin lesions | 597 |
| Removal or shaving of skin growth | 1-10 |
| Skin biopsy | 125 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-130434 | IL | MD | Dermatology Physician |
| 54439-020 | WI | MD | Dermatology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Forefront Dermatology, S.C. | Dermatology | Current | Accepting new patients |
| Forefront Dermatology, S.C. | Dermatology | Current | Accepting new patients |
| Forefront Dermatology, S.C. | Dermatology | Current | Accepting new patients |
| Siu Physicians & Surgeons, Inc | Current | Accepting new patients | |
| Board of Trustees of Southern Illinois University | Current | Accepting new patients | |
| Siu Physicians & Surgeons, Inc | Dermatology | Current | Accepting new patients |
| Siu Physicians & Surgeons, Inc | Past | Accepting new patients | |
| Forefront Dermatology, S.C. | Dermatology | Past | Accepting new patients |
Locations
751 N Rutledge St
Springfield, IL 62702
Phone (217) 545-0182
751 N Rutledge St
Ste 2300
Springfield, IL 62702
Phone (217) 545-3821
1400 Scheuring Rd
De Pere, WI 54115
Phone (920) 964-0229
1245 Cheyenne Ave
Ste 301
Grafton, WI 53024
Phone (262) 377-2222
801 York St
Manitowoc, WI 54220
Phone (866) 630-9882
33 Green Bay Rd
Sturgeon Bay, WI 54235
Phone (920) 746-4434
510 N 17th Ave
Ste C
Wausau, WI 54401
Phone (715) 849-5333
Interoperability endpoints
- elizabeth.nietert@forefrontdermatology.emadirect.md
- elizabethnietert@siusm.allscriptsdirect.net
Organizations & group practices 8
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.
-
dba SIU HealthCare
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- Springfield, IL
- NPI 1558385989
Dermatology
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- Appleton, WI
- NPI 1083768253
-
dba Carbondale Care A Van
- Rural Health Clinic/Center
- Carbondale, IL
- NPI 1215978127
-
- Durable Medical Equipment & Medical Supplies
- Springfield, IL
- NPI 1164055976
-
- Dermatology Physician
- Stevens Point, WI
- NPI 1053679290
-
- Dermatology Physician
- Columbus, OH
- NPI 1063365385
-
- Pediatrics Physician
- Springfield, IL
- NPI 1285657379
-
- Dermatology Physician
- Manitowoc, WI
- NPI 1578515904
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Springfield, IL
- NPI 1255317590
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1786838400000",
"number": "1619199072",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 19644",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627949644",
"telephone_number": "217-545-8000",
"fax_number": "217-545-4485"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "751 N RUTLEDGE ST",
"address_2": "SUITE 2300",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627024968",
"telephone_number": "217-545-3821",
"fax_number": "217-545-4485"
}
],
"practiceLocations": [
{
"address_1": "10500 W Loomis Rd Ste 110",
"address_purpose": "LOCATION",
"city": "Franklin",
"state": "WI",
"postal_code": "531328030",
"country_code": "US",
"telephone_number": "262-898-4400",
"fax_number": "414-858-9104",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "510 N 17TH AVE STE C",
"address_purpose": "LOCATION",
"city": "WAUSAU",
"state": "WI",
"postal_code": "544014281",
"country_code": "US",
"telephone_number": "715-849-5333",
"fax_number": "715-849-4083",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "33 GREEN BAY RD",
"address_purpose": "LOCATION",
"city": "STURGEON BAY",
"state": "WI",
"postal_code": "542352831",
"country_code": "US",
"telephone_number": "920-746-4434",
"fax_number": "920-746-4436",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "NIETERT",
"first_name": "ELIZABETH",
"middle_name": "A",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-03",
"last_updated": "2026-08-16",
"certification_date": "2026-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "WI",
"license": "54439-020",
"primary": false
},
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "IL",
"license": "036-130434",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036130434",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1619199072",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "171400024",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "54439-020",
"state": "WI"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "Elizabeth.Nietert@forefrontdermatology.emadirect.md",
"affiliation": "N",
"address_1": "10500 W Loomis Rd Ste 110",
"city": "Franklin",
"state": "WI",
"country_code": "US",
"postal_code": "531328030",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "Elizabeth.Nietert@forefrontdermatology.emadirect.md",
"affiliation": "N",
"address_1": "510 N 17TH AVE STE C",
"city": "WAUSAU",
"state": "WI",
"country_code": "US",
"postal_code": "544014281",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "Elizabeth.Nietert@forefrontdermatology.emadirect.md",
"affiliation": "N",
"address_1": "33 GREEN BAY RD",
"city": "STURGEON BAY",
"state": "WI",
"country_code": "US",
"postal_code": "542352831",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.