NPIMap

Individual provider Active NPI

Jose M Leiva, MD

  • Family Medicine Physician
  • Brookfield, WI
National Provider Identifier
1962496760
Registry record updated Mar 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
44271 Issued in WI
Practice address
16985 W Bluemound Rd
Brookfield, WI 53005-5909
Phone
(262) 641-8400
NPI assigned
Sep 7, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 44271 WI Primary

Addresses

Primary practice location

16985 W Bluemound Rd
Brookfield, WI 53005-5909

Mailing address

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

Other practice location 1

5471 W Waterford Ln
Appleton, WI 54913-8510
Phone (920) 731-7445

Other identifiers 1

IdentifierTypeStateIssuer
34359400MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/
Direct Messaging Address jleiva394315@direct.myadvocateaurora.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071117000059 WI Practitioner - Family Practice 7113015645 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1993
Medicare assignment
May accept Medicare assignment
Group practices
Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians
Partnership Community Health Center IncGroup PAC ID 2062452600, 9 clinicians

Practice addresses (Care Compare)

1575 N Rivercenter Dr
Milwaukee, WI 53212-3978
Phone (414) 283-8444

5471 W Waterford LN
Appleton, WI 54913-8510
Phone (920) 731-7445

Hospital & facility affiliations

  • Thedacare Regional Med Ctr - Neenah Hospital, Neenah, WI, CCN 520045
  • Aurora Medical Ctr Manitowoc County Hospital, Two Rivers, WI, CCN 520034
  • Ascension NE Wisconsin - St Elizabeth Campus Hospital, Appleton, WI, CCN 520009

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
44271WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Advanced Healthcare, Inc. Family Medicine CurrentSince Feb 1, 2024 Accepting new patients
Lakeshore Medical Clinic LTD Family Medicine CurrentSince Feb 1, 2024 Accepting new patients
Lakeshore Medical Clinic, LLC Family Medicine CurrentSince Feb 1, 2024 Accepting new patients
Aurora Advanced Healthcare Inc CurrentSince Feb 1, 2024 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Feb 1, 2024 Accepting new patients
Aurora Medical Group, Inc. Family Medicine CurrentSince Feb 1, 2024 Accepting new patients
Partnership Community Health Center, Inc CurrentSince Apr 1, 2024 Accepting new patients
Partnership Community Health Center, Inc Past Accepting new patients

Locations

5337 W Grande Market Dr
Appleton, WI 54913
Phone (920) 750-6644

5471 W Waterford Ln
Appleton, WI 54913

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

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

744 S Webster Ave
Green Bay, WI 54301
Phone (920) 433-6025

1814 Appleton Rd
Menasha, WI 54952
Phone (920) 931-1150

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

1575 N Rivercenter Dr
Milwaukee, WI 53212
Phone (414) 283-8444

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

S74W16775 Janesville Rd
Muskego, WI 53150
Phone (414) 422-4747

200 E Ryan Rd
Oak Creek, WI 53154
Phone (414) 570-3590

2000 E Layton Ave
St Francis, WI 53235
Phone (414) 744-7880

Interoperability endpoints

  • Direct secure messaging: jleivathedacare13257@direct.thedacare.org

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 and National Provider Directory roles.

Hospital & facility affiliations 8

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": "1126051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741132800000",
    "number": "1962496760",
    "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": "16985 W BLUEMOUND RD",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530055909",
            "telephone_number": "262-641-8400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5471 W Waterford Ln",
            "address_purpose": "LOCATION",
            "city": "Appleton",
            "state": "WI",
            "postal_code": "549138510",
            "country_code": "US",
            "telephone_number": "920-731-7445",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEIVA",
        "first_name": "JOSE",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-07",
        "last_updated": "2025-03-05",
        "certification_date": "2025-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "44271",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34359400",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "16985 W Bluemound Rd",
            "city": "Brookfield",
            "state": "WI",
            "country_code": "US",
            "postal_code": "530055909",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jleiva394315@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "16985 W Bluemound Rd",
            "city": "Brookfield",
            "state": "WI",
            "country_code": "US",
            "postal_code": "530055909",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Brookfield, WI

Sources for this page

Verify at the official NPI Registry.