NPIMap

Individual provider Active NPI

Marc Bernard Gladden II, D.O.

  • Internal Medicine Physician
  • Beaver Dam, WI
National Provider Identifier
1073802161
Registry record updated Jan 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
62570-20 Issued in WI
Practice address
705 S University Ave Ste 200
Beaver Dam, WI 53916-3079
Phone
(920) 887-9272
NPI assigned
Mar 29, 2011
Last updated
Jan 14, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X 62570-20 WI Primary
Hospitalist Physician 208M00000X 62570-21 WI

Addresses

Primary practice location

705 S University Ave Ste 200
Beaver Dam, WI 53916-3079

Mailing address

705 S University Ave Ste 200
Beaver Dam, WI 53916-3079

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mgladden726718@direct.uwhealth.org

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
I20150321000117 WI Practitioner - Internal Medicine 8820221765 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Lake Erie College of Osteopathic Medicine, Erie, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

705 S University Ave
Suite 200
Beaver Dam, WI 53916-3079
Phone (920) 887-9272

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.32 of 100Reported as group
Quality
87.78
Promoting interoperability
77
Improvement activities
40
Cost
75.8

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
62570-20WIMDInternal Medicine Physician
62570-21WIMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Beaver Dam Community Hospitals Inc CurrentSince Aug 15, 2014 Accepting new patients
University of Wisconsin Medical Foundation, Inc CurrentSince Sep 1, 2017 Accepting new patients
University of Wisconsin Medical Foundation, Inc CurrentSince Sep 1, 2017 Accepting new patients
Beaver Dam Community Hospitals Inc CurrentSince Aug 15, 2014 Accepting new patients
Beaver Dam Community Hospitals Inc Current Accepting new patients
University of Wisconsin System Non Payroll Past Accepting new patients

Locations

705 S University Ave
Beaver Dam, WI 53916
Phone (920) 885-6090

705 S University Ave
Ste 200
Beaver Dam, WI 53916
Phone (920) 887-9272

1000 Mineral Point Ave
Janesville, WI 53548
Phone (608) 261-6868

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

Interoperability endpoints

  • Direct secure messaging: mgladden726718@direct.uwhealth.org

Organizations & group practices 6

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 12

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": "1301356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610582400000",
    "number": "1073802161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "705 S UNIVERSITY AVE STE 200",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539163079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 S UNIVERSITY AVE STE 200",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539163079",
            "telephone_number": "920-887-9272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLADDEN",
        "first_name": "MARC",
        "middle_name": "BERNARD",
        "name_prefix": "Dr.",
        "name_suffix": "II",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-03-29",
        "last_updated": "2021-01-14",
        "certification_date": "2021-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "62570-20",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "WI",
            "license": "62570-21",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mgladden726718@direct.uwhealth.org",
            "affiliation": "N",
            "address_1": "705 S University Ave Ste 200",
            "city": "Beaver Dam",
            "state": "WI",
            "country_code": "US",
            "postal_code": "539163079",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Beaver Dam, WI

Sources for this page

Verify at the official NPI Registry.