Mary Ellen Sabourin, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

32342-020 Issued in WI

Practice address

1310 Broadway
Wisconsin Dells, WI 53965-1358

Phone

(608) 253-1171

Fax

(608) 253-8012

NPI assigned

Apr 25, 2006

Last updated

Apr 5, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Ohio State University College of Medicine, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ho Chunk NationGroup PAC ID 5496709867, 30 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Marshfield Medical Center Hospital, Marshfield, WI, CCN 520037
• Reedsburg Area Medical Center Hospital, Reedsburg, WI, CCN 521351

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Ho-Chunk Nation

  dba Ho-Chunk Health Care Center

  • Federally Qualified Health Center (FQHC)
  • Black River Falls, WI
  • NPI 1407911795
  Medicare reassignment Care Compare group NPD
• Ho Chunk Nation

  dba HO CHUNK NATION d/b/a House of Wellness

  • Federally Qualified Health Center (FQHC)
  • Baraboo, WI
  • NPI 1316002694
  NPD
• St. Marys Dean Ventures Inc.

  • Clinic/Center
  • Baraboo, WI
  • NPI 1811944093
  NPD
• Dean Health Systems, Inc,

  dba Dean Clinic-Beaver Dam Family & Sports Orthopedic Center

  • Durable Medical Equipment & Medical Supplies
  • Beaver Dam, WI
  • NPI 1336425016
  NPD (past)
• Huron Clinic Foundation LTD

  • Family Medicine Physician
  • Huron, SD
  • NPI 1184626962
  NPD (past)

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

• MCHS Hospitals Inc

  dba Marshfield Medical Center

  • Rural Acute Care Hospital
  • Marshfield, WI
  • NPI 1942749387
  Care Compare affiliation
• Reedsburg Area Medical Center, Inc.

  • Family Medicine Physician
  • Reedsburg, WI
  • NPI 1457780983

  Hospital

  Care Compare affiliation
• Reedsburg Area Medical Center, Inc.

  • Critical Access Hospital
  • Reedsburg, WI
  • NPI 1891796710
  Care Compare affiliation

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

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522886400000",
    "number": "1083670277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1310 BROADWAY",
            "city": "WISCONSIN DELLS",
            "state": "WI",
            "postal_code": "539651358",
            "telephone_number": "608-253-1171",
            "fax_number": "608-253-8012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 BROADWAY",
            "city": "WISCONSIN DELLS",
            "state": "WI",
            "postal_code": "539651358",
            "telephone_number": "608-253-1171",
            "fax_number": "608-253-8012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SABOURIN",
        "first_name": "MARY",
        "middle_name": "ELLEN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-25",
        "last_updated": "2018-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "32342-020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1083670277",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rich Rides LLC
• Roxanne Richards, M.D.
• Bridget Therese Riley, BS, MSCMHC, LPC
• Tammy M Rockweiler, APNP
• Gregory Richard Rowe
• School District of Wisconsin Dells
• Erik R Snortum, PT
• Jennifer L. Spady, PA-C
• Lori J Spencer, APNP
• SSM Health Care of Wisconsin Inc (SSM Health St Clare Wi Dells Clinic)

• Family Medicine Physician in Wisconsin Dells, WI
• Providers in Wisconsin Dells, WI by specialty
• Family Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2018; 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.

Verify at the official NPI Registry.