Individual provider Active NPI

Nathaniel John Connovich, PA

  • Physician Assistant
  • Madison, WI
National Provider Identifier
1356962328
Registry record updated Mar 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
7764 Issued in WI
Practice address
7102 Mineral Point Rd
Madison, WI 53717-1706
Phone
(608) 828-7603
Fax
(608) 828-7644
NPI assigned
Apr 30, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 7764 WI Primary

Addresses

Primary practice location

7102 Mineral Point Rd
Madison, WI 53717-1706

Mailing address

7974 Uw Health CT
Middleton, WI 53562-5531

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240229000879 WI Practitioner - Physician Assistant 7719396019 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Loma Linda University School of Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2402 Winnebago St
Madison, WI 53704-5341
Phone (608) 287-2770

600 Highland Ave
Madison, WI 53792-0001
Phone (608) 263-6400

7102 Mineral Point Rd
Madison, WI 53717-1706
Phone (608) 828-7603

7974 Uw Health CT
Middleton, WI 53562-5531

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.32 of 100Reported as group
Quality
87.78
Promoting interoperability
77
Improvement activities
40
Cost
75.8

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
7764WIMDNeonatal Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University of Wisconsin Medical Foundation, Inc CurrentSince Mar 4, 2024 Accepting new patients
University of Wisconsin Medical Foundation, Inc CurrentSince Mar 4, 2024 Accepting new patients
University of Wisconsin Medical Foundation Inc Past Accepting new patients

Locations

7102 Mineral Point Rd
Madison, WI 53717
Phone (608) 828-7603

2402 Winnebago St
Madison, WI 53704
Phone (608) 242-6840

600 Highland Ave
Madison, WI 53792
Phone (608) 263-0325

7974 Uw Health Ct
Middleton, WI 53562
Phone (608) 829-5270

Organizations & group practices 3

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 1

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": "1588204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709510400000",
    "number": "1356962328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7974 UW HEALTH CT",
            "city": "MIDDLETON",
            "state": "WI",
            "postal_code": "535625531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7102 MINERAL POINT RD",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537171706",
            "telephone_number": "608-828-7603",
            "fax_number": "608-828-7644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNOVICH",
        "first_name": "NATHANIEL",
        "middle_name": "JOHN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-30",
        "last_updated": "2024-03-04",
        "certification_date": "2024-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "7764",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

Verify at the official NPI Registry.