Individual provider Active NPI

Vivek Balasubramaniam, MD

  • Pediatric Pulmonology Physician
  • Madison, WI
National Provider Identifier
1003991746
Registry record updated Jan 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Pulmonology PhysicianTaxonomy code 2080P0214X
License
62982-20 Issued in WI
Practice address
600 Highland Ave
Madison, WI 53792-0001
Phone
(608) 263-6420
Fax
(608) 263-0440
NPI assigned
Oct 25, 2006
Last updated
Jan 11, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Pulmonology Physician 2080P0214X 62982-20 WI Primary

Addresses

Primary practice location

600 Highland Ave
Madison, WI 53792-0001

Mailing address

7974 Uw Health CT
Middleton, WI 53562-5531

Other identifiers 1

IdentifierTypeStateIssuer
01373430MedicaidCO

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address vbalasubramaniam738356@direct.uwhealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, IL2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20140930003116 WI Practitioner - Pulmonary DiseasePractitioner - Pediatric Medicine 6002999281 Reassigns benefits to 1 organization
I20160311001651 IL Practitioner - Pulmonary DiseasePractitioner - Pediatric Medicine 6002999281 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
62982-20WIMDPediatric Pulmonology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Swedishamerican Hospital CurrentSince Aug 15, 2016 Accepting new patients
University of Wisconsin Medical Foundation, Inc CurrentSince Oct 1, 2014 Accepting new patients
University of Wisconsin Medical Foundation, Inc CurrentSince Oct 1, 2014 Accepting new patients
Swedishamerican Hospital Family Medicine CurrentSince Aug 15, 2016 Accepting new patients

Locations

3775 N Mulford Rd
Rockford, IL 61114
Phone (779) 696-8400

444 Roxbury Rd
Rockford, IL 61107
Phone (815) 395-9196

6824 Newburg Rd
Rockford, IL 61108
Phone (779) 696-7610

600 Highland Ave
Madison, WI 53792
Phone (608) 263-0325

7974 Uw Health Ct
Middleton, WI 53562
Phone (608) 829-5270

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

Networks

  • IL PPO Downstate
  • devoted network organization-27eb9117-6975-449a-a7ad-909243995ddc
  • devoted network organization-734447cc-691b-4aa7-a112-9c9c8698dcc9
  • IL HMO C-SNP
  • devoted network organization-1baeae7e-6b6f-49f9-a562-1b2d2e55c806

Interoperability endpoints

  • Direct secure messaging: vbalasubramaniam738356@direct.uwhealth.org

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610323200000",
    "number": "1003991746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7974 UW HEALTH CT",
            "city": "MIDDLETON",
            "state": "WI",
            "postal_code": "535625531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 HIGHLAND AVE",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537920001",
            "telephone_number": "608-263-6420",
            "fax_number": "608-263-0440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALASUBRAMANIAM",
        "first_name": "VIVEK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-25",
        "last_updated": "2021-01-11",
        "certification_date": "2021-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0214X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Pulmonology",
            "state": "WI",
            "license": "62982-20",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01373430",
            "state": "CO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "vbalasubramaniam738356@direct.uwhealth.org",
            "affiliation": "N",
            "address_1": "1675 Highland Ave",
            "city": "Madison",
            "state": "WI",
            "country_code": "US",
            "postal_code": "537920002",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

Verify at the official NPI Registry.