Melissa Jean Mork, APNP, RN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

9114-33 Issued in WI

Practice address

4328 Old Green Bay Road
Mount Pleasant, WI 53403

Phone

(262) 687-7606

Fax

(262) 687-7615

NPI assigned

Aug 20, 2010

Last updated

Jun 2, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• Melissa Jean Collins Former name

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

Medicare enrollment (NPD)

Enrolled

Credentials

Registered Nurse

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: melissa.mork.1@14940.direct.athenahealth.com

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.

• Ascension Medical Group-Southeast Wisconsin Inc

  dba Ascension Medical Group

  • Internal Medicine Physician
  • Glendale, WI
  • NPI 1609881077

  Family Medicine

  Medicare reassignment NPD
• Ascension All Saints Hospital, Inc

  dba Ascension Rx 1101

  • Community/Retail Pharmacy
  • Mount Pleasant, WI
  • NPI 1164522132
  NPD (past)
• Everside Health, LLC

  • Clinic/Center
  • Sussex, WI
  • NPI 1942767298

  Family Medicine

  NPD (past)
• Everside Health, LLC

  dba Everside Health - New Berlin

  • Clinic/Center
  • New Berlin, WI
  • NPI 1982150355

  Family Medicine

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1282262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622592000000",
    "number": "1407162092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4328 OLD GREEN BAY ROAD",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "53403",
            "telephone_number": "262-687-7606",
            "fax_number": "262-687-7615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4328 OLD GREEN BAY ROAD",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "53403",
            "telephone_number": "262-687-7606",
            "fax_number": "262-687-7615"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11200 Lincoln Hwy",
            "address_2": "Minute Clinic",
            "address_purpose": "LOCATION",
            "city": "Mokena",
            "state": "IL",
            "postal_code": "604488208",
            "country_code": "US",
            "telephone_number": "815-464-2171",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "240 E Hampton Rd",
            "address_purpose": "LOCATION",
            "city": "Whitefish Bay",
            "state": "WI",
            "postal_code": "532175850",
            "country_code": "US",
            "telephone_number": "414-962-7071 x53217",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MORK",
        "first_name": "MELISSA",
        "middle_name": "JEAN",
        "name_prefix": "Mrs.",
        "credential": "APNP, RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-20",
        "last_updated": "2021-06-02",
        "certification_date": "2021-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "717304",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209012202",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "9114-33",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "APNWI9114-33",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9114-33",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MELISSA",
            "last_name": "COLLINS",
            "middle_name": "JEAN",
            "credential": "APNP, RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Maksim Montatskiy, DMD
• Susan E Moore Schneider, MSW, LCSW
• Angela Christina Morales-Talavera, FNP
• Kryssi Morales, CF-SLP
• Morell Manor LLC
• Kimberlee M Moster, LPC
• Mount Pleasant Eye Care LLC
• Mount Pleasant Family Dentistry LLC
• Mt. Pleasant Chiropractic & Rehab LLC
• Jaclyn M Mueller, PT

• Family Nurse Practitioner in Mount Pleasant, WI
• Providers in Mount Pleasant, WI by specialty
• Family Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.