Individual provider Active NPI

Taylor Thomas Marino, MD

  • Family Medicine Physician
  • Greenfield, WI
National Provider Identifier
1407485949
Registry record updated Jun 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
81075-20 Issued in WI
Practice address
4455 S 108TH St
Greenfield, WI 53228-2504
Phone
(414) 427-5310
NPI assigned
Apr 6, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 81075-20 WI Primary

Addresses

Primary practice location

4455 S 108TH St
Greenfield, WI 53228-2504

Mailing address

4455 S 108TH St
Greenfield, WI 53228-2504
Phone (414) 427-5310

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
I20230818002212 WI Practitioner - Family Practice 6406218627 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

W180N8000 Town Hall Rd
Menomonee Falls, WI 53051-4002
Phone (262) 255-2500

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
81075-20WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. CurrentSince Sep 8, 2023 Accepting new patients
The Medical College of Wisconsin, Inc. Family Medicine Current Accepting new patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. CurrentSince Sep 8, 2023 Accepting new patients

Locations

W168N11237 Western Ave
Germantown, WI 53022
Phone (262) 253-5060

N74W12501 Leatherwood Ct
Menomonee Falls, WI 53051
Phone (414) 454-4744

W180N8000 Town Hall Rd
Menomonee Falls, WI 53051
Phone (262) 255-2500

4455 S 108th St
Milwaukee, WI 53228
Phone (414) 409-7593

1155 N Mayfair Rd
Wauwatosa, WI 53226
Phone (414) 955-5990

Interoperability endpoints

  • Direct secure messaging: tmarino386986@direct.froedtert.com

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": "1586131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688083200000",
    "number": "1407485949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4455 S 108TH ST",
            "city": "GREENFIELD",
            "state": "WI",
            "postal_code": "532282504",
            "telephone_number": "414-427-5310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4455 S 108TH ST",
            "city": "GREENFIELD",
            "state": "WI",
            "postal_code": "532282504",
            "telephone_number": "414-427-5310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARINO",
        "first_name": "TAYLOR",
        "middle_name": "THOMAS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-06",
        "last_updated": "2023-06-30",
        "certification_date": "2023-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "81075-20",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenfield, WI

Sources for this page

Verify at the official NPI Registry.