NPIMap

Individual provider Active NPI

Amy L Fothergill, M.D.

  • Internal Medicine Physician
  • Madison, WI
National Provider Identifier
1063646370
Registry record updated Jan 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
55468-20 Issued in WI
Practice address
4410 Regent St
Associated Physicians, LLP
Madison, WI 53705-4901
Phone
(608) 233-9746
NPI assigned
May 14, 2009
Last updated
Jan 28, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Internal Medicine Physician 207R00000X 55468-20 WI Primary

Addresses

Primary practice location

4410 Regent St
Associated Physicians, LLP
Madison, WI 53705-4901

Mailing address

4410 Regent St
Associated Physicians, LLP
Madison, WI 53705-4901
Phone (608) 233-9746

Other identifiers 2

IdentifierTypeStateIssuer
55468-20OtherWISTATE LICENSE NUMBER
1063646370MedicaidWI

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
I20131024000378 WI Practitioner - Internal Medicine 2365677572 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Mayo Medical School, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Associated Physicians, LLPGroup PAC ID 7719953306, 25 clinicians

Practice addresses (Care Compare)

4410 Regent St
Madison, WI 53705-4901
Phone (608) 233-9746

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
55468-20WIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Luke's Methodist Hospital Current Accepting new patients
Associated Physicians, LLP Internal Medicine CurrentSince Sep 3, 2013 Accepting new patients

Locations

4410 Regent St
Madison, WI 53705
Phone (608) 233-9746

Interoperability endpoints

  • Direct secure messaging: afothergill263364@direct.unitypoint.org

Organizations & group practices 2

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.

Hospital & facility affiliations 8

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": "1242259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1390867200000",
    "number": "1063646370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4410 REGENT ST",
            "address_2": "ASSOCIATED PHYSICIANS, LLP",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537054901",
            "telephone_number": "608-233-9746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4410 REGENT ST",
            "address_2": "ASSOCIATED PHYSICIANS, LLP",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537054901",
            "telephone_number": "608-233-9746"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOTHERGILL",
        "first_name": "AMY",
        "middle_name": "L",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-05-14",
        "last_updated": "2014-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "55468-20",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "55468-20",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1063646370",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

Verify at the official NPI Registry.