Active NPI
David L Peloza, MD
- Allergy & Immunology Physician
- Columbus, WI
National Provider Identifier
1053739714
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Allergy & Immunology Physician
- License
- 65024-20
- Practice address
- 1515 Park Ave
Columbus, WI 53925-2402 - Phone
- (920) 623-2200
- NPI assigned
- Mar 31, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Allergy & Immunology Physician | 207K00000X | 65024-20 | WI | Primary |
Addresses
Primary practice location
1515 Park Ave
Columbus, WI 53925-2402
Mailing address
1515 Park Ave
Columbus, WI 53925-2402
Phone (920) 623-2200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053739714 | Medicaid | WI |
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | dpeloza315978@direct-ehr-ssmhc.com | Direct | |
| FHIR URL | https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ | Other |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Allergy/Immunology
- Education
- University of Wisconsin School of Medicine, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1515 Park Ave
Columbus, WI 53925-1618
Phone (920) 623-2200
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 65024-20 | WI | MD | Allergy & Immunology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prairie Ridge Health Inc. | Current | Accepting new patients | |
| Prairie Ridge Health, Inc. | Current | Accepting new patients | |
| Prairie Ridge Health, Inc. | Current | Accepting new patients | |
| Prairie Ridge Health, Inc. | Current | Accepting new patients |
Locations
1515 Park Ave
#1
Columbus, WI 53925
1515 Park Ave
Columbus, WI 53925
Phone (920) 623-1200
Interoperability endpoints
- dpeloza315978@direct-ehr-ssmhc.com
- https://fhir-myrecord.cerner.com/r4/a87187e5-fe2f-447e-bf32-4eeb3954a735/
Organizations & group practices 5
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.
-
- Critical Access Hospital
- Columbus, WI
- NPI 1154403657
-
- Critical Access Hospital
- Columbus, WI
- NPI 1841376183
-
- Family Medicine Physician
- Sun Prairie, WI
- NPI 1699534545
-
- Orthopaedic Surgery Physician
- Beaver Dam, WI
- NPI 1093137416
-
- Orthopaedic Surgery Physician
- Columbus, WI
- NPI 1912329335
Hospital & facility affiliations 3
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Critical Access Hospital
- Columbus, WI
- NPI 1154403657
-
- Critical Access Hospital
- Columbus, WI
- NPI 1841376183
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1396224000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1740009600000",
"number": "1053739714",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1515 PARK AVE",
"city": "COLUMBUS",
"state": "WI",
"postal_code": "539252402",
"telephone_number": "920-623-2200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1515 PARK AVE",
"city": "COLUMBUS",
"state": "WI",
"postal_code": "539252402",
"telephone_number": "920-623-2200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PELOZA",
"first_name": "DAVID",
"middle_name": "L",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-03-31",
"last_updated": "2025-02-20",
"certification_date": "2025-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "207K00000X",
"taxonomy_group": "",
"desc": "Allergy & Immunology",
"state": "WI",
"license": "65024-20",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1053739714",
"state": "WI"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "dpeloza315978@direct-ehr-ssmhc.com",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "dpeloza315978@direct-ehr-ssmhc.com",
"address_1": "1821 S Stoughton Rd",
"city": "Madison",
"state": "WI",
"country_code": "US",
"postal_code": "537162257",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "FHIR",
"endpointTypeDescription": "FHIR URL",
"endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
"affiliation": "N",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "FHIR API",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "CCD",
"address_1": "1821 S Stoughton Rd",
"city": "Madison",
"state": "WI",
"country_code": "US",
"postal_code": "537162257",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Columbus, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.