NPIMap

Individual provider Active NPI

Melissa Faubert, D.O.

  • Sports Medicine (Family Medicine) Physician
  • Lodi, WI
National Provider Identifier
1194137026
Registry record updated Sep 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
License
69524-21 Issued in WI
Practice address
160 Valley Dr
Lodi, WI 53555-1464
Phone
(608) 592-3296
NPI assigned
May 27, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036.143132 IL
Sports Medicine (Family Medicine) Physician 207QS0010X 69524-21 WI Primary

Addresses

Primary practice location

160 Valley Dr
Lodi, WI 53555-1464

Mailing address

2817 New Pinery Rd
Portage, WI 53901-9240
Phone (608) 745-4598

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180907000587 WI Practitioner - Family Practice 7315242898 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Midwestern University, Chicago College of Osteopathic Med, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sauk Prairie Healthcare Inc 122 clinicians

Practice addresses (Care Compare)

160 Valley Dr
Lodi, WI 53555-1464
Phone (608) 592-3296

Hospital & facility affiliations

  • Sauk Prairie Hospital Hospital, Prairie Du Sac, WI, CCN 520095
  • University of Wi Hospitals & Clinics Authority Hospital, Madison, WI, CCN 520098

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
036.143132ILMDFamily Medicine Physician
69524-21WIMDSports Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sauk Prairie Healthcare Inc Current Accepting new patients
Sauk Prairie Healthcare, Inc. Family Medicine CurrentSince Sep 3, 2023 Accepting new patients
Divine Savior Healthcare, Inc. Family Medicine CurrentSince Aug 1, 2018 Accepting new patients
Sauk Prairie Healthcare Inc Family Medicine CurrentSince Sep 3, 2023 Accepting new patients
Divine Savior Healthcare, Inc. CurrentSince Aug 1, 2018 Accepting new patients
Sauk Prairie Healthcare Inc Family Medicine Past Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

160 Valley Dr
Lodi, WI 53555
Phone (608) 592-3296

2817 New Pinery Rd
Portage, WI 53901
Phone (608) 745-4598

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 12

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1401148800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693958400000",
    "number": "1194137026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2817 NEW PINERY RD",
            "city": "PORTAGE",
            "state": "WI",
            "postal_code": "539019240",
            "telephone_number": "608-745-4598",
            "fax_number": "608-745-6393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 VALLEY DR",
            "city": "LODI",
            "state": "WI",
            "postal_code": "535551464",
            "telephone_number": "608-592-3296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAUBERT",
        "first_name": "MELISSA",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-05-27",
        "last_updated": "2023-09-06",
        "certification_date": "2023-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036.143132",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "WI",
            "license": "69524-21",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lodi, WI

Sources for this page

Verify at the official NPI Registry.