NPIMap

Individual provider Active NPI

Roberta Jo Wedl, MD

  • Family Medicine Physician
  • Whitewater, WI
National Provider Identifier
1497706600
Registry record updated Dec 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
38197-020 Issued in WI
Practice address
1305 W Main St
Whitewater, WI 53190-1503
Phone
(262) 473-4548
Fax
(262) 472-7691
NPI assigned
May 12, 2006
Last updated
Dec 23, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 38197-020 WI Primary

Addresses

Primary practice location

1305 W Main St
Whitewater, WI 53190-1503

Mailing address

1305 W Main St
Whitewater, WI 53190-1503
Phone (262) 473-4548

Other identifiers 1

IdentifierTypeStateIssuer
1497706600MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address rwedl263575@direct-ehr-ssmhc.com Direct
FHIR URL https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ Other

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100220000351 WI Practitioner - Family Practice 6901940527 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Wisconsin School of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Dean Health Systems IncGroup PAC ID 7012827983, 1,174 clinicians

Practice addresses (Care Compare)

700 S Park St
Madison, WI 53715-1830
Phone (608) 251-6100

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions23
Removal of nail tissue1-10
Removal or shaving of skin growth1-10
Skin biopsy15

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
38197-020WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dean Health Systems, Inc Family Medicine CurrentSince Nov 1, 2014 Accepting new patients
Dean Health Systems, Inc. CurrentSince Nov 1, 2014 Accepting new patients

Locations

1700 Tuttle St
Baraboo, WI 53913
Phone (608) 355-3800

1808 W Beltline Hwy
Madison, WI 53713
Phone (608) 250-1497

700 S Park St
Madison, WI 53715
Phone (608) 260-2900

515 22nd Ave
Monroe, WI 53566
Phone (608) 324-1000

1305 W Main St
Whitewater, WI 53190
Phone (262) 472-7686

Ownership & related parties

All facility ownership & control disclosures 7

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Fort Healthcare IncFort Atkinson, WI, CCN 520071 Hospital Corporate Director Jan 1, 2025
Fort Healthcare Internal Medicine and PediatricsFort Atkinson, WI, CCN 528600 Rural health clinic Corporate Officer Nov 3, 2023
Fort Healthcare Integrated Family Care ClinicFort Atkinson, WI, CCN 528595 Rural health clinic Corporate Officer Nov 3, 2023
Fort Healthcare JeffersonJefferson, WI, CCN 528596 Rural health clinic Corporate Officer Nov 3, 2023
Fort Healthcare WhitewaterWhitewater, WI, CCN 528598 Rural health clinic Corporate Officer Nov 3, 2023
Fort Healthcare Center for Womens HealthFort Atkinson, WI, CCN 528599 Rural health clinic Corporate Officer Nov 3, 2023
Fort Healthcare Johnson Creek ClinicJohnson Creek, WI, CCN 528597 Rural health clinic Corporate Officer Nov 3, 2023

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 2

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 11

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": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608681600000",
    "number": "1497706600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1305 W MAIN ST",
            "city": "WHITEWATER",
            "state": "WI",
            "postal_code": "531901503",
            "telephone_number": "262-473-4548",
            "fax_number": "262-472-7691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1305 W MAIN ST",
            "city": "WHITEWATER",
            "state": "WI",
            "postal_code": "531901503",
            "telephone_number": "262-473-4548",
            "fax_number": "262-472-7691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEDL",
        "first_name": "ROBERTA",
        "middle_name": "JO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-12",
        "last_updated": "2020-12-23",
        "certification_date": "2020-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "38197-020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1497706600",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rwedl263575@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "rwedl263575@direct-ehr-ssmhc.com",
            "address_1": "1305 W Main St",
            "city": "Whitewater",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531901503",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "1305 W Main St",
            "city": "Whitewater",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531901503",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Whitewater, WI

Sources for this page

Verify at the official NPI Registry.