Mark Otto Weisse, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

20893 Issued in WI

Practice address

115 W Doty St
PHS Medical Office
Madison, WI 53703-3276

Phone

(608) 284-6071

NPI assigned

Dec 6, 2005

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Bellin Memorial Hospital Inc

  dba Bellin Health

  • Family Medicine Physician
  • Green Bay, WI
  • NPI 1033172390
  NPD (past)
• Preferred Podiatry Group PC

  • Podiatrist
  • Oak Harbor, WA
  • NPI 1720037138
  NPD (past)

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

{
    "created_epoch": "1133827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1154305761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5391 MARINERS COVE DR",
            "address_2": "UNIT 202",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537047615",
            "telephone_number": "608-241-5429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 W DOTY ST",
            "address_2": "PHS MEDICAL OFFICE",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537033276",
            "telephone_number": "608-284-6071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEISSE",
        "first_name": "MARK",
        "middle_name": "OTTO",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "20893",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "20893",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer M Weiss, MD
• John W Weiss, MD PHD
• Monica Weiss, PSY.D.
• Rachel Weiss, RN
• Victor J Weiss
• Andrea Weitz
• Elizabeth Gail Weitz, APNP
• Sam Weitzel
• Annavi Welch
• Ella Welch, MS, MFT

• Family Medicine Physician in Madison, WI
• Providers in Madison, 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 Jul 8, 2007; 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.