Individual provider Active NPI

Elizabeth A Nietert, MD

  • Dermatology Physician
  • Springfield, IL
National Provider Identifier
1619199072
Registry record updated Aug 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
036-130434 Issued in IL
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, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
036130434MedicaidIL
1619199072MedicaidWI
171400024OtherWIMEDICARE
54439-020OtherWISTATE LICENSE

Electronic endpoints 3

TypeEndpointUseAffiliation
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, IL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20101101001543 WI Practitioner - Dermatology 4880888056 Reassigns benefits to 1 organization
I20120920000687 IL Practitioner - Dermatology 4880888056 Reassigns benefits to 1 organization

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
Forefront Dermatology SCGroup PAC ID 3779471701, 650 clinicians
Siu Physicians and Surgeons IncGroup PAC ID 2365352820, 316 clinicians

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 100Reported as group

Merit-based Incentive Payment System (MIPS)

Final score
97.45 of 100Reported as group
Promoting interoperability
97
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions597
Removal or shaving of skin growth1-10
Skin biopsy125

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-130434ILMDDermatology Physician
54439-020WIMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Forefront Dermatology, S.C. Dermatology CurrentSince Aug 1, 2010 Accepting new patients
Forefront Dermatology, S.C. Dermatology CurrentSince Aug 1, 2010 Accepting new patients
Forefront Dermatology, S.C. Dermatology Current Accepting new patients
Siu Physicians & Surgeons, Inc CurrentSince Jul 1, 2012 Accepting new patients
Board of Trustees of Southern Illinois University Current Accepting new patients
Siu Physicians & Surgeons, Inc Dermatology CurrentSince Jul 1, 2012 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

  • Direct secure messaging: elizabeth.nietert@forefrontdermatology.emadirect.md
  • Direct secure messaging: 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.

Hospital & facility affiliations 1

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": "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": []
}

Other providers in Springfield, IL

Sources for this page

Verify at the official NPI Registry.