Individual provider Active NPI

Elizabeth J. Shimeall, PA-C

  • Physician Assistant
  • Pleasant Prairie, WI
National Provider Identifier
1811409162
Registry record updated Apr 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
4012-23 Issued in WI
Practice address
9697 Saint Catherines Dr Ste 200
Pleasant Prairie, WI 53158-2118
Phone
(262) 656-3590
Fax
(262) 656-3591
NPI assigned
Oct 26, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2020

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 4012-23 WI Primary

Addresses

Primary practice location

9697 Saint Catherines Dr Ste 200
Pleasant Prairie, WI 53158-2118

Mailing address

9697 Saint Catherines Dr Ste 200
Pleasant Prairie, WI 53158-2118
Phone (262) 656-3590

Other identifiers 2

IdentifierTypeStateIssuer
4012-23OtherWIWI LICENSE
K400441598OtherWIMEDICARE

Other names 1

  • Elizabeth Seeley Former name

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
I20180117002953 WI Practitioner - Physician Assistant 3173882255 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Rush Medical College of Rush University, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Froedtert South IncGroup PAC ID 9537071196, 158 clinicians

Practice addresses (Care Compare)

6308 8TH Ave
Kenosha, WI 53143-5031
Phone (262) 771-0073

9555 76TH St
Pleasant Prairie, WI 53158-1984
Phone (262) 577-8300

9697 Saint Catherines Dr
Pleasant Prairie, WI 53158-2118
Phone (262) 656-3590

Hospital & facility affiliations

  • Froedtert South Inc. Hospital, Kenosha, WI, CCN 520021

Merit-based Incentive Payment System (MIPS)

Final score
83.15 of 100Reported as group
Quality
69.39
Promoting interoperability
100
Improvement activities
40
Cost
74.44

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Froedtert South, Inc. CurrentSince Dec 4, 2017 Accepting new patients

Locations

6308 8th Ave
Ofc
Kenosha, WI 53143

6308 8th Ave
Kenosha, WI 53143
Phone (262) 653-5300

9697 Saint Catherines Dr
Ste 200
Pleasant Prairie, WI 53158
Phone (262) 656-3590

9697 Saint Catherines Dr
#200
Pleasant Prairie, WI 53158
Phone (262) 577-8000

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.

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": "1508976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586304000000",
    "number": "1811409162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9697 SAINT CATHERINES DR STE 200",
            "city": "PLEASANT PRAIRIE",
            "state": "WI",
            "postal_code": "531582118",
            "telephone_number": "262-656-3590",
            "fax_number": "262-656-3591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9697 SAINT CATHERINES DR STE 200",
            "city": "PLEASANT PRAIRIE",
            "state": "WI",
            "postal_code": "531582118",
            "telephone_number": "262-656-3590",
            "fax_number": "262-656-3591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIMEALL",
        "first_name": "ELIZABETH",
        "middle_name": "J.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-26",
        "last_updated": "2020-04-08",
        "certification_date": "2020-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "4012-23",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WI LICENSE",
            "identifier": "4012-23",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "K400441598",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELIZABETH",
            "last_name": "SEELEY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Pleasant Prairie, WI

Sources for this page

Verify at the official NPI Registry.