Individual provider Active NPI

Mai A Elezaby, MD

  • Diagnostic Radiology Physician
  • Madison, WI
National Provider Identifier
1366525990
Registry record updated Jan 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
49838 Issued in WI
Practice address
600 Highland Ave
Madison, WI 53792-0001
Phone
(608) 263-8340
Fax
(608) 263-0682
NPI assigned
Oct 24, 2006
Last updated
Jan 4, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 49838 WI Primary

Addresses

Primary practice location

600 Highland Ave
Madison, WI 53792-0001

Mailing address

7974 Uw Health CT
Middleton, WI 53562-5531

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address melezaby5502@direct.uwhealth.org

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070109000442 WI Practitioner - Diagnostic Radiology 2466452867 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fort Healthcare IncGroup PAC ID 0840189718, 159 clinicians

Practice addresses (Care Compare)

1111 Highland Ave
Madison, WI 53705-2275
Phone (608) 265-8731

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

6001 Research Park Blvd
Madison, WI 53719-1176
Phone (608) 232-3171

611 Sherman Ave E
Fort Atkinson, WI 53538-1960
Phone (920) 568-1000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
49838WIMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Wisconsin System Non Payroll CurrentSince May 1, 2011 Accepting new patients
Group Health Cooperative of South Central Wisconsin CurrentSince Jun 13, 2024 Accepting new patients
University of Wisconsin System Non Payroll CurrentSince May 1, 2011 Accepting new patients
Fort Healthcare Inc CurrentSince Jul 1, 2011 Accepting new patients
Fort Healthcare Inc CurrentSince Jul 1, 2011 Accepting new patients
University of Wisconsin Medical Foundation, Inc CurrentSince May 1, 2011 Accepting new patients
University of Wisconsin Medical Foundation, Inc CurrentSince May 1, 2011 Accepting new patients

Locations

512 Wilcox St
Fort Atkinson, WI 53538
Phone (920) 563-7366

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

402 W Lake St
Friendship, WI 53934
Phone (608) 339-3331

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

6001 Research Park Blvd
Madison, WI 53719
Phone (608) 232-3171

8202 Excelsior Dr
Madison, WI 53717
Phone (608) 831-1766

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

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/8F7ruIta-JA7ecm4ommy-Q50dF1FkFe4/

Organizations & group practices 7

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 5

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": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609718400000",
    "number": "1366525990",
    "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": "600 HIGHLAND AVE",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537920001",
            "telephone_number": "608-263-8340",
            "fax_number": "608-263-0682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELEZABY",
        "first_name": "MAI",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-24",
        "last_updated": "2021-01-04",
        "certification_date": "2021-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WI",
            "license": "49838",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "melezaby5502@direct.uwhealth.org",
            "affiliation": "N",
            "address_1": "600 Highland Ave",
            "city": "Madison",
            "state": "WI",
            "country_code": "US",
            "postal_code": "537920001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

Verify at the official NPI Registry.