NPIMap

Individual provider Active NPI

Mark A. Clemence, M.D.

  • Internal Medicine Physician
  • Hales Corners, WI
National Provider Identifier
1255324216
Registry record updated Nov 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
34043 Issued in WI
Practice address
6080 S 108TH St
Hales Corners, WI 53130-2557
Phone
(414) 425-5351
Fax
(414) 529-6350
NPI assigned
Aug 25, 2005
Last updated
Nov 17, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2008

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 34043 WI Primary
Infectious Disease Physician 207RI0200X 34043 WI

Addresses

Primary practice location

6080 S 108TH St
Hales Corners, WI 53130-2557

Mailing address

PO Box 689711
Milwaukee, WI 53268-9711
Phone (414) 456-3100

Other identifiers 3

IdentifierTypeStateIssuer
045668480OtherWIMEDICARE PTAN
049873840OtherWIMEDICARE PTAN
32081200MedicaidWI

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
I20080915000406 WI Practitioner - Internal MedicinePractitioner - Infectious Disease 0648183335 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Infectious Disease
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

13950 W Capitol Dr
Brookfield, WI 53005-2441
Phone (414) 302-5400

4935 S 76TH St
Suite 101
Greenfield, WI 53220-4305
Phone (414) 777-3100

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Ascension Medical Group-Southeast Wisconsin Inc Internal Medicine CurrentSince Sep 1, 2008 Accepting new patients
Ascension All Saints Hospital, Inc Past Accepting new patients
Commonwealth Medical Group, LLC Internal Medicine Past Accepting new patients
Wheaton Franciscan Medical Group Internal Medicine Past Accepting new patients

Locations

13950 W Capitol Dr
Brookfield, WI 53005
Phone (414) 302-5400

400 W River Woods Pkwy
#3
Glendale, WI 53212

6080 S 108th St
Hales Corners, WI 53130
Phone (414) 282-5314

2745 W Layton Ave
Ste 206
Milwaukee, WI 53221
Phone (414) 281-9665

3821 Spring St
Mount Pleasant, WI 53405
Phone (262) 687-8460

201 N Mayfair Rd
Fl 2
Wauwatosa, WI 53226
Phone (414) 771-8228

Organizations & group practices 4

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 10

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": "1124928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1226880000000",
    "number": "1255324216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 689711",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532689711",
            "telephone_number": "414-456-3100",
            "fax_number": "414-456-3113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6080 S 108TH ST",
            "city": "HALES CORNERS",
            "state": "WI",
            "postal_code": "531302557",
            "telephone_number": "414-425-5351",
            "fax_number": "414-529-6350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLEMENCE",
        "first_name": "MARK",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-25",
        "last_updated": "2008-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "34043",
            "primary": true
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "WI",
            "license": "34043",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "045668480",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "049873840",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32081200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hales Corners, WI

Sources for this page

Verify at the official NPI Registry.