NPIMap

Individual provider Active NPI

Mark R Zellmer, PA-C

  • Medical Physician Assistant
  • Whitehall, WI
National Provider Identifier
1023013364
Registry record updated Feb 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
507 Issued in WI
Practice address
18606 Ervin St
Whitehall, WI 54773-8613
Phone
(715) 538-4355
NPI assigned
Jun 14, 2005
Last updated
Feb 8, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 8874 MN
Medical Physician Assistant 363AM0700X 507 WI Primary

Addresses

Primary practice location

18606 Ervin St
Whitehall, WI 54773-8613

Mailing address

1836 South Ave
La Crosse, WI 54601-5429
Phone (608) 782-7300

Other identifiers 2

IdentifierTypeStateIssuer
42918400MedicaidWI
874650800MedicaidMN

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
I20040601001433 WI Practitioner - Physician Assistant 6901888387 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tri-County Memorial Hospital IncGroup PAC ID 4587642418, 75 clinicians
St Josephs Health Services IncGroup PAC ID 3971586439, 71 clinicians

Practice addresses (Care Compare)

18601 Lincoln St
Whitehall, WI 54773-8605
Phone (715) 538-4361

400 Water Ave
Hillsboro, WI 54634-9054
Phone (608) 489-8000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
8874MNMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Gundersen Lutheran Express Care, Inc CurrentSince Nov 15, 2010 Accepting new patients
Tri-County Memorial Hospital, Inc. CurrentSince Jun 23, 2010 Accepting new patients
Tri-County Memorial Hospital, Inc. CurrentSince Jan 14, 2026 Accepting new patients
Tri-County Memorial Hospital, Inc. CurrentSince Jun 23, 2010 Accepting new patients
Gundersen Clinic LTD CurrentSince Nov 15, 2010 Accepting new patients
Moundview Memorial Hospital & Clinics, Inc. CurrentSince Feb 20, 2023 Accepting new patients
St. Joseph's Health Services, Inc. CurrentSince Feb 8, 2023 Accepting new patients
Moundview Memorial Hospital & Clinics, Inc. CurrentSince Feb 20, 2023 Accepting new patients
St. Joseph's Health Services, Inc. CurrentSince Feb 8, 2023 Accepting new patients
Moundview Memorial Hospital & Clinics, Inc Past Accepting new patients
Gundersen Clinic LTD Past Accepting new patients

Locations

402 W Lake St
Friendship, WI 53934
Phone (608) 339-3331

1836 South Ave
La Crosse, WI 54601
Phone (608) 788-8102

1600 Main St
Onalaska, WI 54650
Phone (608) 783-4681

18601 Lincoln St
Whitehall, WI 54773
Phone (715) 538-1712

18606 Ervin St
Whitehall, WI 54773
Phone (715) 538-4330

Interoperability endpoints

  • Direct secure messaging: mzellmer8091@direct.emplifyhealth.org

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 11

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": "1118707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675814400000",
    "number": "1023013364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1836 SOUTH AVE",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546015429",
            "telephone_number": "608-782-7300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18606 ERVIN ST",
            "city": "WHITEHALL",
            "state": "WI",
            "postal_code": "547738613",
            "telephone_number": "715-538-4355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZELLMER",
        "first_name": "MARK",
        "middle_name": "R",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-14",
        "last_updated": "2023-02-08",
        "certification_date": "2023-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "8874",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WI",
            "license": "507",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42918400",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "874650800",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Whitehall, WI

Sources for this page

Verify at the official NPI Registry.