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DR. MARY LIZETTA SIRACUSA MD
NPI 1861020422
Student in an Organized Health Care Education/Training Program in Milwaukee, WI

Active since March 30, 2020Opted out of Medicare · through Nov 1, 2026
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226(414) 805-6600 Get Directions Write a Review

NPPES record last updated: March 30, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dr. Mary Lizetta Siracusa Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. MARY LIZETTA SIRACUSA MD (NPI 1861020422) is an individual student in an organized health care education/training program in Milwaukee, Wisconsin and active in the NPI registry since March 2020. She has opted out of Medicare through November 1, 2026 and remains eligible to order and refer.

NPPES Registry Identity

NPI1861020422
Entity TypeIndividualFemale
Primary Taxonomy390200000X
Provider Legal NameDR. MARY LIZETTA SIRACUSACredential: MD
Location Address9200 W WISCONSIN AVEMilwaukee, WI 53226-3522
Mailing Address9200 W Wisconsin AveMilwaukee, WI 53226-3522 · (414) 805-6600
Phone(414) 805-6600
Sole ProprietorNo
Enumeration DateMarch 30, 2020
NPPES CertifiedMarch 30, 2020
✔ NPI 1861020422 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
9200 W WISCONSIN AVE, Milwaukee, WI 53226
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Mary Lizetta Siracusa Md has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from November 1, 2024 through November 1, 2026.

Opt-Out Effective DateNovember 1, 2024
Opt-Out In Effect ThroughNovember 1, 2026Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

TRACY BLAIR WANDTKE HERRMANN APNP, CNM
Advanced Practice Midwife
9200 W WISCONSIN AVE
MILWAUKEE, WI 53226
Milwaukee County (414) 805-4777
DR. ZACHARY SMITH DO
Internal Medicine (Gastroenterology)
9200 W WISCONSIN AVE
MILWAUKEE, WI 53226
Milwaukee County (414) 955-6830
DR. COLLEEN ANN CROWE M.D., M.P.H.
Emergency Medicine
9200 W WISCONSIN AVE
MILWAUKEE, WI 53226
Milwaukee County (414) 805-6469
ROBERTO MEJIAS APNP
Nurse Practitioner (Pediatrics)
9200 W WISCONSIN AVE
MILWAUKEE, WI 53226
Milwaukee County (414) 805-6600
MRS. ANNE E B LAKATOS APN-BC, APNP, RN
Nurse Practitioner (Adult Health)
9200 W WISCONSIN AVE, DEPT OF INTERNAL MEDICINE
MILWAUKEE, WI 53226
Milwaukee County (414) 805-6850
MRS. AMANDA M MANDERS APNP
Nurse Practitioner (Adult Health)
9200 W WISCONSIN AVE
MILWAUKEE, WI 53226
Milwaukee County (414) 805-6850
KATHLEEN A WATERHOUSE-SKIBICKI CRNA
Nurse Anesthetist, Certified Registered
9200 W WISCONSIN AVE
MILWAUKEE, WI 53226
Milwaukee County (414) 805-5951
ANDREA L BEQUEST PA
Physician Assistant (Medical)
9200 W WISCONSIN AVE, INTERNAL MEDICINE
MILWAUKEE, WI 53226
Milwaukee County (414) 955-0350

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mary Siracusa's NPI number?

The NPI number for Mary Siracusa is 1861020422. It was assigned to this individual provider in the NPPES registry on March 30, 2020.

Where is Mary Siracusa located?

Mary Siracusa practices at 9200 W Wisconsin Ave, Milwaukee, WI 53226. The listed phone number is (414) 805-6600.

What is Mary Siracusa's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Mary Siracusa enrolled in Medicare?

No. Mary Siracusa has opted out of Medicare through November 1, 2026. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Mary Siracusa was last updated on March 30, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.