Active NPI
Anna V Kleyman, D.O.
- Family Medicine Physician
- Port Washington, WI
National Provider Identifier
1720303670
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 56890
- Practice address
- 1475 W Grand Ave
Port Washington, WI 53074-2074 - Phone
- (262) 268-5100
- NPI assigned
- Apr 5, 2010
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 56890 | WI | Primary |
Addresses
Primary practice location
1475 W Grand Ave
Port Washington, WI 53074-2074
Mailing address
PO Box 735044
Chicago, IL 60673-5044
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100030851 | Medicaid | WI |
Other names 1
- Anna V. Polikanov
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | akleyman7382@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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- University of Iowa, RJ & L Carver College of Medicine, 2010
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1475 W Grand Ave
Port Washington, WI 53074-2074
Phone (262) 268-5100
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 56890 | WI | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aurora Advanced Healthcare Inc | Current | Accepting new patients | |
| Aurora Advanced Healthcare, Inc. | Family Medicine | Current | 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
1475 W Grand Ave
Port Washington, WI 53074
Phone (262) 268-5100
Organizations & group practices 2
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.
-
- Family Medicine Physician
- Milwaukee, WI
- NPI 1265629133
-
- Durable Medical Equipment & Medical Supplies
- Summit, WI
- NPI 1477186633
Hospital & facility affiliations 4
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Cudahy, WI
- NPI 1235355983
Hospital
-
- General Acute Care Hospital
- Milwaukee, WI
- NPI 1861447179
-
- General Acute Care Hospital
- Grafton, WI
- NPI 1265740195
-
dba Aurora at Home
- Home Health Agency
- West Allis, WI
- NPI 1134255037
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1270425600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1696809600000",
"number": "1720303670",
"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"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1475 W GRAND AVE",
"city": "PORT WASHINGTON",
"state": "WI",
"postal_code": "530742074",
"telephone_number": "262-268-5100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KLEYMAN",
"first_name": "ANNA",
"middle_name": "V",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-04-05",
"last_updated": "2023-10-09",
"certification_date": "2023-10-09",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WI",
"license": "56890",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100030851",
"state": "WI"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "akleyman7382@direct.myadvocateaurora.org",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "1475 W Grand Ave",
"city": "Port Washington",
"state": "WI",
"country_code": "US",
"postal_code": "530742074",
"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": "1475 W Grand Ave",
"city": "Port Washington",
"state": "WI",
"country_code": "US",
"postal_code": "530742074",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"first_name": "ANNA",
"last_name": "POLIKANOV",
"middle_name": "V.",
"credential": "D.O.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Port Washington, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2023; 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.