Individual provider Active NPI

Carolyn Jean Reabe, MD

  • Addiction Psychiatry Physician
  • Columbus, WI
National Provider Identifier
1235109638
Registry record updated Sep 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Psychiatry PhysicianTaxonomy code 2084P0802X
License
51265-20 Issued in WI
Practice address
1515 Park Ave
Columbus, WI 53925-2402
Phone
(920) 623-2200
NPI assigned
Jan 26, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 22, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction Psychiatry Physician 2084P0802X 51265-20 WI Primary

Addresses

Primary practice location

1515 Park Ave
Columbus, WI 53925-2402

Mailing address

1515 Park Ave
Columbus, WI 53925-2402
Phone (920) 623-2200

Other names 1

  • Carolyn Jean Baxter Former name

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20080219000829 WI Practitioner - Psychiatry 4981508827 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
University of Oklahoma College of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Prairie Ridge Health IncGroup PAC ID 6800791484, 70 clinicians

Practice addresses (Care Compare)

1515 Park Ave
Columbus, WI 53925-1618
Phone (920) 623-2200

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
51265-20WIMDAddiction Psychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prairie Ridge Health, Inc. CurrentSince Oct 1, 2022 Accepting new patients
Prairie Ridge Health, Inc. CurrentSince Jan 20, 2026 Accepting new patients
Prairie Ridge Health Inc. CurrentSince Oct 1, 2022 Accepting new patients
Bridgepoint Health LLC Past Accepting new patients
St. John Physicians, Inc. Past Accepting new patients
Jeffrey K McIlroy MD Inc Past Accepting new patients

Locations

1515 Park Ave
Columbus, WI 53925
Phone (920) 623-1200

Interoperability endpoints

  • Direct secure messaging: creabe434023@direct-ehr-ssmhc.com

Organizations & group practices 7

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 3

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": "1138233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663804800000",
    "number": "1235109638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 PARK AVE",
            "city": "COLUMBUS",
            "state": "WI",
            "postal_code": "539252402",
            "telephone_number": "920-623-2200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 PARK AVE",
            "city": "COLUMBUS",
            "state": "WI",
            "postal_code": "539252402",
            "telephone_number": "920-623-2200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REABE",
        "first_name": "CAROLYN",
        "middle_name": "JEAN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-01-26",
        "last_updated": "2022-09-22",
        "certification_date": "2022-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0802X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Psychiatry",
            "state": "WI",
            "license": "51265-20",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CAROLYN",
            "last_name": "BAXTER",
            "middle_name": "JEAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Columbus, WI

Sources for this page

Verify at the official NPI Registry.