Individual provider Active NPI

Carli R Gurholt, PSYD

  • Psychologist
  • Marshfield, WI
National Provider Identifier
1255059333
Registry record updated Aug 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
5047 Issued in WI
Practice address
1000 N Oak Ave
Marshfield, WI 54449-5702
Phone
(715) 387-5511
NPI assigned
Aug 16, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 5047 WI Primary

Addresses

Primary practice location

1000 N Oak Ave
Marshfield, WI 54449-5702

Mailing address

1000 N Oak Ave
Marshfield, WI 54449-5702

Other identifiers 1

IdentifierTypeStateIssuer
3902000000XMedicaidWI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address him@marshfieldclinichealthsystem.cernerdirect.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230829001961 WI Practitioner - Psychologist Billing Independently 4688037302 Reassigns benefits to 10 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
80.58 of 100Reported as group
Quality
55.5
Promoting interoperability
100
Improvement activities
40
Cost
71.46

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
MCHS Hospitals Inc Current Accepting new patients
In Depth Psychotherapy, LLC CurrentSince Jan 25, 2023 Accepting new patients
Flambeau Hospital Inc CurrentSince Aug 29, 2023 Accepting new patients
Flambeau Hospital Inc CurrentSince Aug 29, 2023 Accepting new patients
MCHS Hospitals Inc CurrentSince Aug 29, 2023 Accepting new patients
Lakeview Medical Center Inc of Rice Lake CurrentSince Aug 29, 2023 Accepting new patients
Beaver Dam Community Hospitals Inc CurrentSince Aug 29, 2023 Accepting new patients
Marshfield Clinic Inc CurrentSince Aug 29, 2023 Accepting new patients
MCHS Hospitals Inc CurrentSince Aug 29, 2023 Accepting new patients
Beaver Dam Community Hospitals Inc CurrentSince Aug 29, 2023 Accepting new patients
Memorial Hospital Inc CurrentSince Aug 29, 2023 Accepting new patients

Locations

705 S University Ave
Beaver Dam, WI 53916
Phone (920) 885-6090

1000 Starr Ave
Eau Claire, WI 54703
Phone (715) 858-4850

3501 Golf Rd
Eau Claire, WI 54701
Phone (715) 858-4200

1000 N Oak Ave
Fl 2
Marshfield, WI 54449

1000 N Oak Ave
Marshfield, WI 54449
Phone (715) 387-5111

1102 S Center Ave
Merrill, WI 54452
Phone (715) 536-3399

N3708 River Ave
Neillsville, WI 54456
Phone (715) 743-3101

1700 W Stout St
Rice Lake, WI 54868
Phone (715) 236-6133

10425 W North Ave
Ste 239
Wauwatosa, WI 53226
Phone (414) 376-0674

Interoperability endpoints

  • Direct secure messaging: carli.gurholt@marshfieldclinichealthsystem.cernerdirect.com
  • Direct secure messaging: him@marshfieldclinichealthsystem.cernerdirect.com

Organizations & group practices 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1660608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693180800000",
    "number": "1255059333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 N OAK AVE",
            "city": "MARSHFIELD",
            "state": "WI",
            "postal_code": "544495702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 N OAK AVE",
            "city": "MARSHFIELD",
            "state": "WI",
            "postal_code": "544495702",
            "telephone_number": "715-387-5511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GURHOLT",
        "first_name": "CARLI",
        "middle_name": "R",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-16",
        "last_updated": "2023-08-28",
        "certification_date": "2023-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WI",
            "license": "5047",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3902000000X",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "him@marshfieldclinichealthsystem.cernerdirect.com",
            "affiliation": "N",
            "address_1": "1000 N Oak Ave",
            "city": "Marshfield",
            "state": "WI",
            "country_code": "US",
            "postal_code": "544495702",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Marshfield, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.