Individual provider Active NPI

Mark C Wickre, MD

  • Diagnostic Radiology Physician
  • La Crosse, WI
National Provider Identifier
1063830628
Registry record updated Oct 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
73555 Issued in WI
Practice address
1836 South Ave
La Crosse, WI 54601-5429
Phone
(608) 782-7300
NPI assigned
Apr 1, 2014
Last updated
Oct 21, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 61383 MN
Diagnostic Radiology Physician 2085R0202X 73555 WI Primary

Addresses

Primary practice location

1836 South Ave
La Crosse, WI 54601-5429

Mailing address

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

Other practice location 1

420 Delaware St SE
G254 Mayo Building
Minneapolis, MN 55455-0341
Phone (612) 625-7634

Other practice location 2

200 1st St SW
Rochester, MN 55905-0001
Phone (507) 284-2511

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, IA, WI3 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 3

Enrollment IDStateProvider typePAC IDDetails
I20190829000058 MN Practitioner - Diagnostic Radiology 9436454451 Reassigns benefits to 3 organizations
I20201022002479 IA Practitioner - Diagnostic Radiology 9436454451 Reassigns benefits to 4 organizations
I20201105000580 WI Practitioner - Diagnostic Radiology 9436454451 Reassigns benefits to 10 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gundersen Lutheran Medical Center IncGroup PAC ID 2163331414, shared by 16 NPIs, 888 clinicians
Gundersen Clinic LTDGroup PAC ID 9638082779, 422 clinicians
Tri-County Memorial Hospital IncGroup PAC ID 4587642418, 75 clinicians
St Josephs Health Services IncGroup PAC ID 3971586439, 71 clinicians

Practice addresses (Care Compare)

1122 W Hwy 61
Winona, MN 55987-1957
Phone (507) 615-0600

1200 Grant Blvd W
Wabasha, MN 55981-1042
Phone (651) 565-4531

1830 State Hwy 9
Decorah, IA 52101-7301
Phone (563) 382-3140

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

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

1910 S Ave
La Crosse, WI 54601-5467
Phone (608) 782-7300

226 2ND St N
Lacrescent, MN 55947-1111
Phone (507) 895-6610

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
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
61383MNMDDiagnostic Radiology Physician
73555WIMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Gundersen Lutheran Express Care, Inc CurrentSince Oct 5, 2020 Accepting new patients
Tri-County Memorial Hospital, Inc. CurrentSince Oct 23, 2020 Accepting new patients
St. Joseph's Health Services, Inc. Current Accepting new patients
Veterans Memorial Hospital City of Waukon Ia Current Accepting new patients
Gundersen Lutheran Medical Center Inc Current Accepting new patients
Veterans Memorial Hospital City of Waukon Ia CurrentSince Jul 1, 2022 Accepting new patients
Saint Elizabeths Hospital of Wabasha Inc CurrentSince May 27, 2021 Accepting new patients
Gundersen Lutheran Medical Center Inc Current Accepting new patients
Tri-County Memorial Hospital, Inc. CurrentSince Oct 23, 2020 Accepting new patients
Veterans Memorial Hospital City of Waukon Ia CurrentSince Jul 1, 2022 Accepting new patients
Veterans Memorial Hospital City of Waukon Ia Current Accepting new patients
Gundersen Clinic LTD CurrentSince Oct 5, 2020 Accepting new patients
Memorial Hospital of Boscobel CurrentSince Oct 5, 2020 Accepting new patients
Vernon Memorial Healthcare, Inc. CurrentSince Nov 30, 2020 Accepting new patients
St. Joseph's Health Services, Inc. CurrentSince Oct 23, 2020 Accepting new patients
Gundersen Clinic LTD CurrentSince Oct 5, 2020 Accepting new patients
Saint Elizabeths Hospital of Wabasha Inc CurrentSince Mar 1, 2021 Accepting new patients
Moundview Memorial Hospital & Clinics, Inc. CurrentSince Oct 19, 2020 Accepting new patients
Gundersen Lutheran Medical Center, Inc CurrentSince Oct 5, 2020 Accepting new patients
St. Joseph's Health Services, Inc. CurrentSince Oct 23, 2020 Accepting new patients
Moundview Memorial Hospital & Clinics, Inc Current Accepting new patients
Memorial Hospital of Boscobel CurrentSince Oct 5, 2020 Accepting new patients
Gundersen Clinic LTD CurrentSince Oct 5, 2020 Accepting new patients
Moundview Memorial Hospital & Clinics, Inc. CurrentSince Oct 19, 2020 Accepting new patients
Gundersen Lutheran Medical Center, Inc CurrentSince Oct 5, 2020 Accepting new patients
Palmer Lutheran Health Center, Inc. CurrentSince Nov 25, 2020 Accepting new patients
Saint Elizabeths Hospital of Wabasha Inc CurrentSince Mar 1, 2021 Accepting new patients
Gundersen Lutheran Medical Center Inc CurrentSince Oct 5, 2020 Accepting new patients

Locations

1830 State Highway 9
Decorah, IA 52101
Phone (563) 382-2639

40 1st St SE
Waukon, IA 52172
Phone (563) 568-3411

112 Jefferson St
West Union, IA 52175
Phone (563) 422-3811

123 5th Ave SE
Spring Grove, MN 55974
Phone (507) 498-3302

1200 Grant Blvd W
Wabasha, MN 55981
Phone (651) 565-4531

1122 W Highway 61
Winona, MN 55987
Phone (507) 615-0600

205 Parker St
Boscobel, WI 53805
Phone (608) 375-4112

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

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

1910 South Ave
La Crosse, WI 54601
Phone (608) 775-2287

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

610 E Taylor St
Prairie du Chien, WI 53821
Phone (608) 326-6466

507 S Main St
Viroqua, WI 54665
Phone (608) 637-2101

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

Interoperability endpoints

  • Direct secure messaging: mwickre474004@direct.emplifyhealth.org

Organizations & group practices 28

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 28

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1396310400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603238400000",
    "number": "1063830628",
    "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": "1836 SOUTH AVE",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546015429",
            "telephone_number": "608-782-7300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "420 Delaware St SE",
            "address_2": "G254 Mayo Building",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554550341",
            "country_code": "US",
            "telephone_number": "612-625-7634",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "200 1st St SW",
            "address_purpose": "LOCATION",
            "city": "Rochester",
            "state": "MN",
            "postal_code": "559050001",
            "country_code": "US",
            "telephone_number": "507-284-2511",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WICKRE",
        "first_name": "MARK",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-01",
        "last_updated": "2020-10-21",
        "certification_date": "2020-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MN",
            "license": "61383",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WI",
            "license": "73555",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Crosse, WI

Sources for this page

Verify at the official NPI Registry.