Elana Fran Wistrom, DO

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

57321-21 Issued in WI

Practice address

2825 Prairie Ave
Beloit, WI 53511-1844

Phone

(608) 363-5500

Fax

(608) 363-5539

NPI assigned

Aug 19, 2008

Last updated

Jan 21, 2013By 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 2

Addresses

Other identifiers 3

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

Obstetrics/Gynecology

Education

At Still University of Health Sciences, College of Osteo Med, Kirksville, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mercy Health System CorporationGroup PAC ID 7416860440, 749 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mercy Health System Corp Hospital, Janesville, WI, CCN 520066

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ewistrom15704@direct.mhemail.org

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.

• Mercy Health System Corporation

  dba MHS Physician Services

  • Multi-Specialty Clinic/Center
  • Janesville, WI
  • NPI 1598718603
  Medicare reassignment Care Compare group NPD
• Mercy Health System Corporation

  dba Mercy Hospital Janesville

  • General Acute Care Hospital
  • Janesville, WI
  • NPI 1093768962
  NPD
• Mercy Health System Corporation

  dba Mercy Walworth Hospital and Medical Center

  • Critical Access Hospital
  • Lake Geneva, WI
  • NPI 1699728550
  NPD
• Mercy Health System Corporation

  dba Mercy Beloit Medical Center

  • Durable Medical Equipment & Medical Supplies
  • Beloit, WI
  • NPI 1619000437
  NPD (past)
• Mercy Health System Corporation

  dba Mercy Walworth Hospital and Medical Center

  • Prosthetic/Orthotic Supplier
  • Lake Geneva, WI
  • NPI 1710124698
  NPD (past)

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

• Mercy Health System Corporation

  dba Mercy Hospital Janesville

  • General Acute Care Hospital
  • Janesville, WI
  • NPI 1093768962
  Care Compare affiliation

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

{
    "created_epoch": "1219104000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1358726400000",
    "number": "1134376486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2825 PRAIRIE AVE",
            "city": "BELOIT",
            "state": "WI",
            "postal_code": "535111844",
            "telephone_number": "608-363-5500",
            "fax_number": "608-363-5539"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2825 PRAIRIE AVE",
            "city": "BELOIT",
            "state": "WI",
            "postal_code": "535111844",
            "telephone_number": "608-363-5500",
            "fax_number": "608-363-5539"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISTROM",
        "first_name": "ELANA",
        "middle_name": "FRAN",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-19",
        "last_updated": "2013-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MI",
            "license": "5101017794",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "WI",
            "license": "57321-21",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1134376486",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MERCYCARE INSURANCE",
            "identifier": "WISTRELA",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSWI",
            "identifier": "1134376486",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kassandra Elizabeth Wilson
• Nancy J. Wilson, M.D.
• Shawn P Wilson, MD
• Wisconsin CVS Pharmacy LLC (CVS Pharmacy# 05600)
• Wisconsin Therapists LTD.
• Camryn A Withrow, SAC-IT
• Gretchen R Witowich, MS, RD, LDN
• Colleen E Wolf, PA-C
• Elizabeth Marie Wood, MS, RD, CD
• Laura Ann Woodberry, RN

• Obstetrics & Gynecology Physician in Beloit, WI
• Providers in Beloit, WI by specialty
• Obstetrics & Gynecology Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2013; 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.