Individual provider Active NPI

Maureen C Payant McKenna, MD

  • Emergency Medicine Physician
  • Madison, WI
National Provider Identifier
1275766016
Registry record updated Feb 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
5624820 Issued in WI
Practice address
3033 Irvington Way
Madison, WI 53713-3413
Phone
(608) 381-7799
NPI assigned
Aug 27, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 57653 TN
Emergency Medicine Physician 207P00000X 5624820 WI Primary

Addresses

Primary practice location

3033 Irvington Way
Madison, WI 53713-3413

Mailing address

3033 Irvington Way
Madison, WI 53713-3413
Phone (608) 381-7799

Other practice location 1

800 Riverside Dr
Waupaca, WI 54981-1943
Phone (715) 258-1000

Other practice location 2

112 E 5th Ave
Antigo, WI 54409-2710
Phone (715) 623-2331

Other identifiers 1

IdentifierTypeStateIssuer
ENROLLEDMedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, IL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20170703001107 WI Practitioner - Emergency Medicine 3870761455 Reassigns benefits to 5 organizations
I20190710000212 IL Practitioner - Emergency Medicine 3870761455

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Florida State University College of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Swea Fort SCGroup PAC ID 0345774972, 51 clinicians

Practice addresses (Care Compare)

611 Sherman Ave E
Fort Atkinson, WI 53538-1960
Phone (920) 568-5475

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5624820WIMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Thedacare Medical Center - New London, Inc CurrentSince Jan 14, 2025 Accepting new patients
Thedacare Medical Center - Waupaca, Inc. CurrentSince Jan 14, 2025 Accepting new patients
Thedacare Medical Center - Shawano, Inc. CurrentSince Jan 14, 2025 Accepting new patients
Thedacare Medical Center - New London, Inc. CurrentSince Jan 14, 2025 Accepting new patients
Richard S Veiga MD SC Current Accepting new patients
Thedacare Medical Center - Berlin, Inc. CurrentSince Jan 14, 2025 Accepting new patients
Thedacare Medical Center - Shawano, Inc. CurrentSince Jan 14, 2025 Accepting new patients
Thedacare Medical Center - Waupaca, Inc. Emergency Medicine CurrentSince Jan 14, 2025 Accepting new patients
Swea Fort SC Emergency Medicine CurrentSince Dec 1, 2024 Accepting new patients
Thedacare Medical Center - Berlin, Inc. CurrentSince Jan 14, 2025 Accepting new patients

Locations

225 Memorial Dr
Berlin, WI 54923
Phone (920) 361-1313

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

1405 Mill St
New London, WI 54961
Phone (920) 531-2000

100 Cty Road B
Shawano, WI 54166
Phone (715) 524-2161

800 Riverside Dr
Waupaca, WI 54981
Phone (715) 258-1000

Organizations & group practices 10

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 2

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": "1251331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739404800000",
    "number": "1275766016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3033 IRVINGTON WAY",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537133413",
            "telephone_number": "608-381-7799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3033 IRVINGTON WAY",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537133413",
            "telephone_number": "608-381-7799"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 Riverside Dr",
            "address_purpose": "LOCATION",
            "city": "Waupaca",
            "state": "WI",
            "postal_code": "549811943",
            "country_code": "US",
            "telephone_number": "715-258-1000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "112 E 5th Ave",
            "address_purpose": "LOCATION",
            "city": "Antigo",
            "state": "WI",
            "postal_code": "544092710",
            "country_code": "US",
            "telephone_number": "715-623-2331",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PAYANT MCKENNA",
        "first_name": "MAUREEN",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-27",
        "last_updated": "2025-02-13",
        "certification_date": "2025-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TN",
            "license": "57653",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WI",
            "license": "5624820",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ENROLLED",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

Verify at the official NPI Registry.