Individual provider Active NPI

Emily Marie Novicki, PA-C

  • Physician Assistant
  • Milwaukee, WI
National Provider Identifier
1639699457
Registry record updated Nov 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
4014-23 Issued in WI
Practice address
2901 W Kinnickinnic River Pkwy Ste 507
Milwaukee, WI 53215-3660
Phone
(414) 649-3780
NPI assigned
Jun 22, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2023

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 4014-23 WI Primary

Addresses

Primary practice location

2901 W Kinnickinnic River Pkwy Ste 507
Milwaukee, WI 53215-3660

Mailing address

PO Box 735044
Chicago, IL 60673-5044
Phone (414) 646-3780

Other practice location 1

813 W 5th St
Marshfield, WI 54449
Phone (715) 207-8430

Other practice location 2

W180N11070 River Ln
Germantown, WI 53022-3109
Phone (715) 207-8430

Other identifiers 1

IdentifierTypeStateIssuer
100070158MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/
Direct Messaging Address enovicki175621@direct.myadvocateaurora.org

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
I20170901001014 WI Practitioner - Physician Assistant 5496028078 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
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

2900 W Oklahoma Ave
Milwaukee, WI 53215-4330
Phone (414) 646-5410

975 Port Washington Rd
Grafton, WI 53024-9204
Phone (262) 329-8650

Hospital & facility affiliations

  • Aurora St Lukes Medical Center Hospital, Milwaukee, WI, CCN 520138
  • Aurora Medical Center Hospital, Grafton, WI, CCN 520207

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4014-23WIMDPhysician Assistant
4014WIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Advanced Healthcare Inc CurrentSince Aug 7, 2017 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Jun 4, 2018 Accepting new patients
Aurora Advanced Healthcare, Inc. CurrentSince Aug 7, 2017 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Jun 4, 2018 Accepting new patients
Aurora Medical Group, Inc. PastSince Nov 19, 2023 Accepting new patients

Locations

W180N11070 River Ln
Germantown, WI 53022
Phone (262) 532-9700

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

975 Port Washington Rd
Ste 110
Grafton, WI 53024
Phone (262) 329-1000

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

2901 W Kinnickinnic River Pkwy
Ste 507
Milwaukee, WI 53215
Phone (414) 649-3480

2900 W Oklahoma Ave
Milwaukee, WI 53215
Phone (414) 385-2590

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

36500 Aurora Dr
Summit, WI 53066
Phone (262) 434-1000

Interoperability endpoints

  • Direct secure messaging: enovicki175621@direct.myadvocateaurora.org

Organizations & group practices 5

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.

Hospital & facility affiliations 3

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": "1498089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699920000000",
    "number": "1639699457",
    "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": "414-646-3780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2901 W KINNICKINNIC RIVER PKWY STE 507",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532153660",
            "telephone_number": "414-649-3780"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "813 W 5th St",
            "address_purpose": "LOCATION",
            "city": "Marshfield",
            "state": "WI",
            "postal_code": "54449",
            "country_code": "US",
            "telephone_number": "715-207-8430",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "W180N11070 River Ln",
            "address_purpose": "LOCATION",
            "city": "Germantown",
            "state": "WI",
            "postal_code": "530223109",
            "country_code": "US",
            "telephone_number": "715-207-8430",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NOVICKI",
        "first_name": "EMILY",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-22",
        "last_updated": "2023-11-14",
        "certification_date": "2023-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "4014-23",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100070158",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "W180N11070 River Ln",
            "city": "Germantown",
            "state": "WI",
            "country_code": "US",
            "postal_code": "530223109",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "enovicki175621@direct.myadvocateaurora.org",
            "affiliation": "N",
            "address_1": "W180N11070 River Ln",
            "city": "Germantown",
            "state": "WI",
            "country_code": "US",
            "postal_code": "530223109",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.