NPIMap

Individual provider Active NPI

Jacob Tyler McCallum, DO

  • Diagnostic Radiology Physician
  • Middleton, WI
National Provider Identifier
1194210492
Registry record updated Jul 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
81114 Issued in WI
Practice address
8430 Market St Apt 118
Middleton, WI 53562-4782
Phone
(612) 328-1583
NPI assigned
Jun 28, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 5101024188 MI
Diagnostic Radiology Physician 2085R0202X 81114 WI Primary

Addresses

Primary practice location

8430 Market St Apt 118
Middleton, WI 53562-4782

Mailing address

8430 Market St Apt 118
Middleton, WI 53562-4782

Other practice location 1

221 Michigan St NE Ste 402
Grand Rapids, MI 49503-2538
Phone (616) 391-1929

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
I20230714002946 WI Practitioner - Diagnostic Radiology 8527302702 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dean Health Systems IncGroup PAC ID 7012827983, 1,174 clinicians
Madison Radiologists S CGroup PAC ID 1951209311, 58 clinicians

Practice addresses (Care Compare)

1211 Fish Hatchery Rd
Madison, WI 53715-1909
Phone (608) 252-8000

8430 Market St
Apt 118
Middleton, WI 53562-4782
Phone (614) 340-7740

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101024188MIMDDiagnostic Radiology Physician
81114WIMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fort Healthcare Inc Current Accepting new patients
Dean Health Systems, Inc CurrentSince Jul 3, 2023 Accepting new patients
Fort Healthcare Inc CurrentSince Jul 1, 2023 Accepting new patients
Fort Healthcare, Inc. CurrentSince Jul 1, 2023 Accepting new patients
Group Health Cooperative of South Central Wisconsin CurrentSince Jul 2, 2023 Accepting new patients
Madison Radiologists S C Diagnostic Radiology CurrentSince Jul 18, 2023 Accepting new patients
Dean Health Systems, Inc. CurrentSince Jul 3, 2023 Accepting new patients
Michigan Medical Patient Care Past Accepting new patients

Locations

611 Sherman Ave E
Fort Atkinson, WI 53538
Phone (920) 563-6667

1000 Mineral Point Ave
Janesville, WI 53548
Phone (608) 261-6868

600 Highland Ave
Madison, WI 53792
Phone (608) 263-0325

1211 Fish Hatchery Rd
Madison, WI 53715
Phone (608) 252-8000

8202 Excelsior Dr
Madison, WI 53717
Phone (608) 831-1766

515 22nd Ave
Monroe, WI 53566
Phone (608) 324-1000

333 E 2nd St
Richland Ctr, WI 53581
Phone (608) 647-6161

900 Ridge St
Stoughton, WI 53589
Phone (608) 231-3410

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/8F7ruIta-JA7ecm4ommy-Q50dF1FkFe4/

Organizations & group practices 8

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.

Hospital & facility affiliations 6

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": "1530144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721692800000",
    "number": "1194210492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8430 MARKET ST APT 118",
            "city": "MIDDLETON",
            "state": "WI",
            "postal_code": "535624782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8430 MARKET ST APT 118",
            "city": "MIDDLETON",
            "state": "WI",
            "postal_code": "535624782",
            "telephone_number": "612-328-1583"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "221 Michigan St NE Ste 402",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495032538",
            "country_code": "US",
            "telephone_number": "616-391-1929",
            "fax_number": "616-391-3130",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCCALLUM",
        "first_name": "JACOB",
        "middle_name": "TYLER",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-28",
        "last_updated": "2024-07-23",
        "certification_date": "2024-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MI",
            "license": "5101024188",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WI",
            "license": "81114",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Middleton, WI

Sources for this page

Verify at the official NPI Registry.