NPIMap

Individual provider Active NPI

Melissa Elaine Lucarelli, MD

  • Family Medicine Physician
  • Randolph, WI
National Provider Identifier
1336102169
Registry record updated Jul 13, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
36988020 Issued in WI
Practice address
504 S High Street
Randolph, WI 53956
Phone
(920) 326-5060
Fax
(920) 326-5061
NPI assigned
Apr 11, 2006
Last updated
Jul 13, 2010By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 36988020 WI Primary

Addresses

Primary practice location

504 S High Street
Randolph, WI 53956

Mailing address

504 S High St
PO Box 101
Randolph, WI 53956-1499
Phone (920) 326-5060

Other identifiers 3

IdentifierTypeStateIssuer
11573OtherWIDEAN HEALTH PLAN
32327000MedicaidWI
080174465OtherRAILROAD MEDICARE

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
I20101021000682 WI Practitioner - Family Practice 1254227119 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Illinois Medical College, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Randolph Community Clinic SCGroup PAC ID 1456247311, 3 clinicians

Practice addresses (Care Compare)

504 S High St
Randolph, WI 53956-1499
Phone (920) 326-5060

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.66 of 100Reported as individual
Quality
100
Promoting interoperability
100
Improvement activities
40
Cost
82.19

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions19
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
36988020WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
MCHS Hospitals Inc Current Accepting new patients

Interoperability endpoints

  • Direct secure messaging: melissa.lucarelli.1@11574.direct.athenahealth.com
  • Direct secure messaging: melissa.lucarelli@marshfieldclinichealthsystem.cernerdirect.com

Organizations & group practices 2

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 12

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": "1144713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1278979200000",
    "number": "1336102169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 S HIGH ST",
            "address_2": "PO BOX 101",
            "city": "RANDOLPH",
            "state": "WI",
            "postal_code": "539561499",
            "telephone_number": "920-326-5060",
            "fax_number": "920-326-5061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 S HIGH STREET",
            "city": "RANDOLPH",
            "state": "WI",
            "postal_code": "53956",
            "telephone_number": "920-326-5060",
            "fax_number": "920-326-5061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUCARELLI",
        "first_name": "MELISSA",
        "middle_name": "ELAINE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-11",
        "last_updated": "2010-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "36988020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEAN HEALTH PLAN",
            "identifier": "11573",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32327000",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080174465",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Randolph, WI

Sources for this page

Verify at the official NPI Registry.