Individual provider Active NPI

Charlene Vander Zanden, M.D.

  • Internal Medicine Physician
  • Milwaukee, WI
National Provider Identifier
1235339532
Registry record updated Feb 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
54553-20 Issued in WI
Practice address
1155 N Mayfair Rd
Plank Road Clinic
Milwaukee, WI 53226-3462
Phone
(414) 955-5990
Fax
(414) 955-6282
NPI assigned
Jul 24, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 54553-20 WI Primary

Addresses

Primary practice location

1155 N Mayfair Rd
Plank Road Clinic
Milwaukee, WI 53226-3462

Mailing address

1155 N Mayfair Rd
Plank Road Clinic
Milwaukee, WI 53226-3462
Phone (414) 955-5990

Other identifiers 1

IdentifierTypeStateIssuer
1235339532MedicaidWI

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
I20101211000029 WI Practitioner - Internal Medicine 4688861008 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Medical College of Wisconsin, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Prohealth Medical Group IncGroup PAC ID 3476465188, 475 clinicians

Practice addresses (Care Compare)

2750 Golf Rd
Delafield, WI 53018-2062
Phone (262) 928-4900

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
54553-20WIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prohealth Medical Group Inc. Internal Medicine CurrentSince Apr 1, 2022 Accepting new patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. Internal Medicine Current Accepting new patients
Prohealth Medical Group Inc Internal Medicine CurrentSince Apr 1, 2022 Accepting new patients
The Medical College of Wisconsin, Inc. Internal Medicine CurrentSince Sep 5, 2010 Accepting new patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. CurrentSince May 1, 2013 Accepting new patients
Prohealth Medical Group Inc Internal Medicine Past Accepting new patients

Locations

2750 Golf Rd
Delafield, WI 53018
Phone (262) 928-4900

W168N11237 Western Ave
Germantown, WI 53022
Phone (262) 253-5060

10911 N Port Washington Rd
Mequon, WI 53092
Phone (262) 241-2080

Bin 88350
Milwaukee, WI 53288
Phone (414) 805-3122

N14W23900 Stone Ridge Dr
Waukesha, WI 53188
Phone (262) 549-3030

N17W24100 Riverwood Dr
Waukesha, WI 53188
Phone (262) 820-3093

840 N 87th St
Wauwatosa, WI 53226
Phone (414) 805-5540

1155 N Mayfair Rd
Wauwatosa, WI 53226
Phone (414) 955-5990

8701 Watertown Plank Rd
Wauwatosa, WI 53226
Phone (414) 456-4100

Interoperability endpoints

  • Direct secure messaging: cvanderzanden38187@direct.phci.org

Organizations & group practices 6

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 5

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": "1185235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391990400000",
    "number": "1235339532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1155 N MAYFAIR RD",
            "address_2": "PLANK ROAD CLINIC",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532263462",
            "telephone_number": "414-955-5990",
            "fax_number": "414-955-6282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1155 N MAYFAIR RD",
            "address_2": "PLANK ROAD CLINIC",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532263462",
            "telephone_number": "414-955-5990",
            "fax_number": "414-955-6282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDER ZANDEN",
        "first_name": "CHARLENE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-24",
        "last_updated": "2014-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "54553-20",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1235339532",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.