Individual provider Active NPI

Thaddeus C Whiting, DO

  • Family Medicine Physician
  • Portage, WI
National Provider Identifier
1497792113
Registry record updated Dec 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
49668 Issued in WI
Practice address
2825 Hunters TRL
Portage, WI 53901-3429
Phone
(608) 742-7161
Fax
(608) 745-3990
NPI assigned
Jun 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2021

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 49668 WI Primary

Addresses

Primary practice location

2825 Hunters TRL
Portage, WI 53901-3429

Mailing address

2825 Hunters TRL
Portage, WI 53901-3429
Phone (608) 742-7161

Other practice location 1

2817 New Pinery Rd
Divine Savior Healthcare, Inc.
Portage, WI 53901-0387
Phone (608) 745-4598

Other practice location 2

Ascension-Plover Clinic
2401 Plover Road
Plover, WI 54467
Phone (715) 295-3800

Other identifiers 1

IdentifierTypeStateIssuer
1497792113MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address twhiting408293@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: 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
I20081029000494 WI Practitioner - Family Practice 1557429925 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
R Franklin University of Med & Sci/Chicago Medical School, 2005
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)

2825 Hunters TRL
Portage, WI 53901-3429
Phone (608) 742-5522

Hospital & facility affiliations

  • SSM Health at Home Home Health-Wisconsin Home health agency, Madison, WI, CCN 527184
  • SSM Health St Mary'S Hospital - Madison Hospital, Madison, WI, CCN 520083
  • SSM Health St Clare Hospital - Baraboo Hospital, Baraboo, WI, CCN 520057
  • Aspirus Divine Savior Hospital Hospital, Portage, WI, CCN 520041

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
49668WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dean Health Systems, Inc Family Medicine CurrentSince Nov 26, 2021 Accepting new patients
Divine Savior Healthcare, Inc. CurrentSince Oct 1, 2008 Accepting new patients
Dean Health Systems, Inc. CurrentSince Nov 26, 2021 Accepting new patients
Divine Savior Healthcare, Inc. Family Medicine CurrentSince Oct 1, 2008 Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

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

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

2817 New Pinery Rd
Portage, WI 53901
Phone (608) 745-4598

2825 Hunters Trl
Portage, WI 53901
Phone (608) 742-5522

Interoperability endpoints

  • Direct secure messaging: twhiting408293@direct-ehr-ssmhc.com

Organizations & group practices 4

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 4

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": "1149120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638748800000",
    "number": "1497792113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2825 HUNTERS TRL",
            "city": "PORTAGE",
            "state": "WI",
            "postal_code": "539013429",
            "telephone_number": "608-742-7161",
            "fax_number": "608-745-3990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2825 HUNTERS TRL",
            "city": "PORTAGE",
            "state": "WI",
            "postal_code": "539013429",
            "telephone_number": "608-742-7161",
            "fax_number": "608-745-3990"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2817 New Pinery Rd",
            "address_2": "Divine Savior Healthcare, Inc.",
            "address_purpose": "LOCATION",
            "city": "Portage",
            "state": "WI",
            "postal_code": "539010387",
            "country_code": "US",
            "telephone_number": "608-745-4598",
            "fax_number": "608-745-6242",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "Ascension-Plover Clinic",
            "address_2": "2401 Plover Road",
            "address_purpose": "LOCATION",
            "city": "Plover",
            "state": "WI",
            "postal_code": "54467",
            "country_code": "US",
            "telephone_number": "715-295-3800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WHITING",
        "first_name": "THADDEUS",
        "middle_name": "C",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-01",
        "last_updated": "2021-12-06",
        "certification_date": "2021-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "49668",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1497792113",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "twhiting408293@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "twhiting408293@direct-ehr-ssmhc.com",
            "address_1": "2825 Hunters Trl",
            "city": "Portage",
            "state": "WI",
            "country_code": "US",
            "postal_code": "539013429",
            "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": "2825 Hunters Trl",
            "city": "Portage",
            "state": "WI",
            "country_code": "US",
            "postal_code": "539013429",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Portage, WI

Sources for this page

Verify at the official NPI Registry.