Richard J Qualy, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

28576 Issued in WI

Practice address

2977 County Hwy CX
Portage, WI 53901

Phone

(608) 742-3004

Fax

(608) 742-2399

NPI assigned

Jul 25, 2006

Sex

Male

Sole proprietor

No

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Randolph Community Clinic SC

  • Family Medicine Physician
  • Randolph, WI
  • NPI 1497832257

  Family Medicine

  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 27, 2009.

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1243382400000",
    "number": "1124041728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7974 UW HEALTH CT",
            "city": "MIDDLETON",
            "state": "WI",
            "postal_code": "535625531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2977 COUNTY HWY CX",
            "city": "PORTAGE",
            "state": "WI",
            "postal_code": "53901",
            "telephone_number": "608-742-3004",
            "fax_number": "608-742-2399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUALY",
        "first_name": "RICHARD",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-25",
        "last_updated": "2009-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "28576",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Portage Care Living LLC
• Portage Community Schools
• Portage Radiology, SC
• Portcare Home LLC
• Andrew Taylor Putney, MD
• Susan I Quiriconi, MSW CICSW
• Matthew Gregory Rajala, PA
• Kevin M Rak, MD
• Tomi Randall
• Kristin Ranum, LCSW

• All providers in Portage, WI
• Family Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.