Individual provider Active NPI

Savannah Mickesh, APN

  • Nurse Practitioner
  • Milwaukee, WI
National Provider Identifier
1962009381
Registry record updated Dec 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
11358 Issued in WI
Practice address
2801 W Kinnickinnic River Pkwy
Milwaukee, WI 53215-3669
Phone
(414) 281-4466
NPI assigned
Oct 8, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 11358 WI Primary

Addresses

Primary practice location

2801 W Kinnickinnic River Pkwy
Milwaukee, WI 53215-3669

Mailing address

PO Box 735044
Chicago, IL 60673-5044
Phone (800) 326-2250

Other identifiers 1

IdentifierTypeStateIssuer
100189676MedicaidWI

Electronic endpoints 3

TypeEndpointUseAffiliation
Other URL EHR
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/
Direct Messaging Address sharirie58713@direct.myadvocateaurora.org Direct

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
I20211122001745 WI Practitioner - Nurse Practitioner 5890100036 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
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)

2801 W Kinnickinnic River Pkwy
Milwaukee, WI 53215-3669
Phone (414) 385-8600

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
11358WIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Medical Group, Inc. CurrentSince Nov 15, 2021 Accepting new patients
Aurora Advanced Healthcare Inc CurrentSince Nov 15, 2021 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Nov 15, 2021 Accepting new patients
Aurora Advanced Healthcare, Inc. Family Medicine CurrentSince Nov 15, 2021 Accepting new patients
Aurora Medical Group, Inc. Family Medicine Current Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients

Locations

16985 W Bluemound Rd
Brookfield, WI 53005
Phone (262) 641-8400

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

215 Washington St
Grafton, WI 53024
Phone (262) 375-3700

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

2801 W Kinnickinnic River Pkwy
Ste 560
Milwaukee, WI 53215
Phone (414) 649-3920

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

3301 W Forest Home Ave
Milwaukee, WI 53215
Phone (414) 389-2233

2801 W Kinnickinnic River Pkwy
Milwaukee, WI 53215
Phone (414) 384-5111

4600 W Loomis Rd
Ste 201
Milwaukee, WI 53220

Interoperability endpoints

  • Direct secure messaging: sharirie58713@direct.myadvocateaurora.org

Organizations & group practices 6

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 2

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": "1602115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733875200000",
    "number": "1962009381",
    "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": "800-326-2250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 W KINNICKINNIC RIVER PKWY",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532153669",
            "telephone_number": "414-281-4466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICKESH",
        "first_name": "SAVANNAH",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-08",
        "last_updated": "2024-12-11",
        "certification_date": "2024-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "11358",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100189676",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "EHR",
            "affiliation": "N",
            "address_1": "67 E Ridgewood Ave",
            "city": "Paramus",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "076523623",
            "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": "2801 W Kinnickinnic River Pkwy",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532153669",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sharirie58713@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2801 W Kinnickinnic River Pkwy",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532153669",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.