NPIViewer - Provider NPI 1427271378

NPI:	1427271378
Name:	AURORA MEDICAL GROUP, INC.
Entity type:	Organization
Organization Name:	AURORA MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:	SVP
Authorized Official - Prefix:
Authorized Official - First Name:	NAN
Authorized Official - Middle Name:
Authorized Official - Last Name:	NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:	414-219-1610
Mailing Address - Street 1:	PO BOX 735044
Mailing Address - Street 2:
Mailing Address - City:	CHICAGO
Mailing Address - State:	IL
Mailing Address - Zip Code:	60673-5044
Mailing Address - Country:	US
Mailing Address - Phone:	877-576-3544
Mailing Address - Fax:
Practice Address - Street 1:	3301 W FOREST HOME AVE
Practice Address - Street 2:
Practice Address - City:	MILWAUKEE
Practice Address - State:	WI
Practice Address - Zip Code:	53215-2843
Practice Address - Country:	US
Practice Address - Phone:	877-576-3544
Practice Address - Fax:
EIN:	<UNAVAIL>
Is Organization Subpart?:	No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:	2007-04-10
Last Update Date:	2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:

Primary?	Code	Type	Classification	Specialization	Group
Yes	207Q00000X	Allopathic & Osteopathic Physicians	Family Medicine		Group - Multi-Specialty
No	207R00000X	Allopathic & Osteopathic Physicians	Internal Medicine		Group - Multi-Specialty
No	261QM0801X	Ambulatory Health Care Facilities	Clinic/Center	Mental Health (Including Community Mental Health Center)	Group - Multi-Specialty

State	Identifier ID	ID Type
WI	32762100	Medicaid
WI	32838500	Medicaid
WI	32841800	Medicaid
WI	32844700	Medicaid
WI	32878000	Medicaid
WI	32895600	Medicaid
WI	32749100	Medicaid
WI	32826200	Medicaid
WI	32829500	Medicaid
WI	32852100	Medicaid
WI	32871900	Medicaid
WI	32891500	Medicaid
WI	42234500	Medicaid
WI	21268100	Medicaid
WI	32830000	Medicaid
WI	32816700	Medicaid
WI	42215800	Medicaid
WI	32838200	Medicaid
WI	32872300	Medicaid
WI	32843400	Medicaid
WI	32844600	Medicaid
WI	32878000	Medicaid
WI	32852100	Medicaid
WI	000065185	Medicare PIN
WI	42234500	Medicaid
WI	32841800	Medicaid
WI	000001325	Medicare PIN
WI	000073665	Medicare PIN
WI	000068700	Medicare PIN
WI	32872300	Medicaid
WI	32844600	Medicaid
WI	32762100	Medicaid
WI	000073225	Medicare PIN
WI	000068080	Medicare PIN
WI	000073975	Medicare PIN
WI	32843400	Medicaid
WI	32829500	Medicaid
WI	000068600	Medicare PIN
WI	000001820	Medicare PIN
WI	42215800	Medicaid