Christina A Calvello, MD
Individual provider Active NPI Obstetrics & Gynecology Physician · Fond Du Lac, WI
NPI 1104836394 · NPPES record last updated Oct 19, 2020
Key facts
- NPI
- 1104836394
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Obstetrics & Gynecology Physician 207V00000X
- License
- 54731-20 (WI)
- Practice address
- 420 E Division St
Fond Du Lac, WI 54935-4560 - Phone
- (920) 926-8450
- Fax
- (920) 926-8891
- NPI assigned
- Aug 9, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 22
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Obstetrics/Gynecology
- Education
- Chicago College of Medicine and Surgery, 1995
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Agnesian Healthcare Inc
Practice addresses (Care Compare)
420 E Division St
Fond Du Lac, WI 54935-4560
Phone (920) 923-7400
Hospital & facility affiliations
- SSM Health St Agnes Hospital-Fond Du Lac
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101122001015 | WI | Practitioner - Obstetrics/Gynecology | 7012921315 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 54731-20 | WI | MD | Obstetrics & Gynecology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Agnesian Healthcare Inc | Current |
Accepting new patients | |
| Agnesian Healthcare, Inc | Current | Accepting new patients | |
| Agnesian Healthcare Inc | Current |
Accepting new patients | |
| Women First Consultants, Obstetrics & Gynecology, S.C. | Obstetrics & Gynecology | Past |
Accepting new patients |
| Community Medical Center of Green Lake, LLC | Past | Accepting new patients | |
| Together Women'S Health Medical Group of Illinois, PLLC | Past |
Accepting new patients | |
| Jeffrey G. Bentson, M.D., PLLC | Past | Accepting new patients |
Locations
225 Memorial Dr
Berlin, WI 54923
Phone (920) 361-1313
420 E Division St
Fond du Lac, WI 54935
Phone (920) 923-7400
Interoperability endpoints
- ccalvello316291@direct-ehr-ssmhc.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 54731-20 | WI | Yes |
Addresses
Primary practice location
420 E Division St
Fond Du Lac, WI 54935-4560
Mailing address
420 E Division St
Fond Du Lac, WI 54935-4560
Phone (920) 926-8340
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104836394 | Medicaid | WI |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | ccalvello316291@direct-ehr-ssmhc.com | Direct | |
| FHIR URL | https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ | Other |
Other providers in Fond Du Lac, WI
- Ryan Butcher
- Natalie D Cady
- Steven M Cahee
- Jammi G Cairns
- Katie Calmes
- Scott A Calvert
- Tabitha Campagna
- Jacob Thomas Cannestra
- Gilberto Cantu
- Kelley Cantu
All providers in Fond Du Lac, WI · Obstetrics & Gynecology Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 19, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.