Individual provider Active NPI

Mark E. Nordness, M.D.

  • Allergy & Immunology Physician
  • Mukwonago, WI
National Provider Identifier
1457324428
Registry record updated Nov 23, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Allergy & Immunology PhysicianTaxonomy code 207K00000X
License
41406 Issued in WI
Practice address
240 Maple Avenue
Prohealth Care Medical Associates Inc.
Mukwonago, WI 53149
Phone
(262) 928-1900
Fax
(262) 363-1949
NPI assigned
Feb 9, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy & Immunology Physician 207K00000X 41406 WI Primary
Pediatrics Physician 208000000X 41406-020 WI

Addresses

Primary practice location

240 Maple Avenue
Prohealth Care Medical Associates Inc.
Mukwonago, WI 53149

Mailing address

N17 W24100 Riverwood Drive Suite 250
Prohealth Care Medical Associates Inc.
Waukesha, WI 53149
Phone (262) 928-4100

Other identifiers 1

IdentifierTypeStateIssuer
34064800MedicaidWI

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
I20100727000451 WI Practitioner - Allergy/ImmunologyPractitioner - Pediatric Medicine 8527191675 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Allergy/ImmunologyAlso: Pediatric Medicine
Education
Medical College of Wisconsin, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Prohealth Medical Group IncGroup PAC ID 3476465188, 475 clinicians

Practice addresses (Care Compare)

N16W24131 Riverwood Dr
Waukesha, WI 53188-1106
Phone (262) 696-0808

Hospital & facility affiliations

  • Waukesha Memorial Hospital Hospital, Waukesha, WI, CCN 520008

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
41406-020WIMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prohealth Medical Group Inc. Allergy & Immunology CurrentSince Oct 1, 2010 Accepting new patients
Prohealth Medical Group Inc CurrentSince Oct 1, 2010 Accepting new patients
Prohealth Medical Group Inc Allergy & Immunology Past Accepting new patients

Locations

195 Discovery Dr
Brookfield, WI 53045
Phone (262) 513-7100

W180N8085 Town Hall Rd
Menomonee Fls, WI 53051
Phone (262) 257-5000

400 Bay View Rd
Mukwonago, WI 53149
Phone (262) 363-1900

240 Maple Ave
Mukwonago, WI 53149
Phone (262) 928-1900

N17W24100 Riverwood Dr
Ste 250
Waukesha, WI 53188

N17W24100 Riverwood Dr
Waukesha, WI 53188
Phone (262) 820-3093

N14W23900 Stone Ridge Dr
Waukesha, WI 53188
Phone (262) 549-3030

N16W24131 Riverwood Dr
Waukesha, WI 53188
Phone (262) 696-0696

Interoperability endpoints

  • Direct secure messaging: mnordness15533@direct.phci.org

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": "1139443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1322006400000",
    "number": "1457324428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N17 W24100 RIVERWOOD DRIVE SUITE 250",
            "address_2": "PROHEALTH CARE MEDICAL ASSOCIATES INC.",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "53149",
            "telephone_number": "262-928-4100",
            "fax_number": "262-928-5835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 MAPLE AVENUE",
            "address_2": "PROHEALTH CARE MEDICAL ASSOCIATES INC.",
            "city": "MUKWONAGO",
            "state": "WI",
            "postal_code": "53149",
            "telephone_number": "262-928-1900",
            "fax_number": "262-363-1949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NORDNESS",
        "first_name": "MARK",
        "middle_name": "E.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-09",
        "last_updated": "2011-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "WI",
            "license": "41406",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WI",
            "license": "41406-020",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34064800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mukwonago, WI

Sources for this page

Verify at the official NPI Registry.