Active NPI
Melissa L Tate, APNP
- Family Nurse Practitioner
- Fond Du Lac, WI
National Provider Identifier
1346667151
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 5710
- Practice address
- 912 S Hickory St
Fond Du Lac, WI 54935-5530 - Phone
- (920) 907-3922
- NPI assigned
- Mar 19, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 5710 | WI | Primary |
Addresses
Primary practice location
912 S Hickory St
Fond Du Lac, WI 54935-5530
Mailing address
912 S Hickory St
Fond Du Lac, WI 54935-5530
Phone (920) 907-9322
Other practice location 1
845 Parkside St
Ripon, WI 54971-8505
Phone (920) 748-3101
Other practice location 2
620 W Brown St
Waupun, WI 53963-1702
Phone (920) 324-5581
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | mtate331863@direct-ehr-ssmhc.com | Direct | |
| FHIR URL | https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ | Other |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Agnesian Healthcare, Inc | Past | Accepting new patients |
Interoperability endpoints
- mtate331863@direct-ehr-ssmhc.com
Organizations & group practices 1
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.
-
- General Acute Care Hospital
- Fond Du Lac, WI
- NPI 1346228541
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1395187200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1651622400000",
"number": "1346667151",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "912 S HICKORY ST",
"city": "FOND DU LAC",
"state": "WI",
"postal_code": "549355530",
"telephone_number": "920-907-9322",
"fax_number": "920-929-7392"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "912 S HICKORY ST",
"city": "FOND DU LAC",
"state": "WI",
"postal_code": "549355530",
"telephone_number": "920-907-3922"
}
],
"practiceLocations": [
{
"address_1": "845 Parkside St",
"address_purpose": "LOCATION",
"city": "Ripon",
"state": "WI",
"postal_code": "549718505",
"country_code": "US",
"telephone_number": "920-748-3101",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "620 W Brown St",
"address_purpose": "LOCATION",
"city": "Waupun",
"state": "WI",
"postal_code": "539631702",
"country_code": "US",
"telephone_number": "920-324-5581",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "TATE",
"first_name": "MELISSA",
"middle_name": "L",
"credential": "APNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-03-19",
"last_updated": "2022-05-04",
"certification_date": "2022-05-04",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "WI",
"license": "5710",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "mtate331863@direct-ehr-ssmhc.com",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "mtate331863@direct-ehr-ssmhc.com",
"address_1": "912 S Hickory St",
"city": "Fond Du Lac",
"state": "WI",
"country_code": "US",
"postal_code": "549355530",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "FHIR",
"endpointTypeDescription": "FHIR URL",
"endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
"affiliation": "N",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "FHIRAPI",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "CCD",
"address_1": "912 S Hickory St",
"city": "Fond Du Lac",
"state": "WI",
"country_code": "US",
"postal_code": "549355530",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Fond Du Lac, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.