Individual provider Active NPI

Gwenevere Charles McIntosh, MD

  • Pediatrics Physician
  • Madison, WI
National Provider Identifier
1487620647
Registry record updated Jan 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
42577 Issued in WI
Practice address
5249 E Terrace Dr
Madison, WI 53718
Phone
(608) 265-1295
Fax
(608) 265-0935
NPI assigned
Feb 27, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 42577 WI Primary

Addresses

Primary practice location

5249 E Terrace Dr
Madison, WI 53718

Mailing address

7974 Uw Health CT
Middleton, WI 53562-5531

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address gmcintosh22269@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
I20070305000105 WI Practitioner - Pediatric Medicine 7012019482 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
42577WIMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Wisconsin Medical Foundation, Inc CurrentSince Feb 11, 2010 Accepting new patients
University of Wisconsin Medical Foundation, Inc CurrentSince Feb 11, 2010 Accepting new patients
University of Wisconsin Medical Foundation Inc Past Accepting new patients

Locations

5249 E Terrace Dr
Madison, WI 53718
Phone (608) 222-9777

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.

NPI Registry JSON

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

{
    "created_epoch": "1140998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610409600000",
    "number": "1487620647",
    "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": "5249 E TERRACE DR",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "53718",
            "telephone_number": "608-265-1295",
            "fax_number": "608-265-0935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCINTOSH",
        "first_name": "GWENEVERE",
        "middle_name": "CHARLES",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-27",
        "last_updated": "2021-01-12",
        "certification_date": "2021-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WI",
            "license": "42577",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gmcintosh22269@direct.uwhealth.org",
            "affiliation": "N",
            "address_1": "5249 E Terrace Dr",
            "city": "Madison",
            "state": "WI",
            "country_code": "US",
            "postal_code": "53718",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

Verify at the official NPI Registry.