Individual provider Active NPI

Trudy A Mara, APNP

  • Nurse Practitioner
  • Baraboo, WI
National Provider Identifier
1558326967
Registry record updated Dec 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
994 Issued in WI
Practice address
1700 Tuttle St
Baraboo, WI 53913-3319
Phone
(608) 356-2145
Fax
(608) 356-2147
NPI assigned
Apr 19, 2006
Last updated
Dec 10, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 994 WI Primary

Addresses

Primary practice location

1700 Tuttle St
Baraboo, WI 53913-3319

Mailing address

1700 Tuttle St
Baraboo, WI 53913-3319
Phone (608) 356-2145

Other identifiers 1

IdentifierTypeStateIssuer
1558326967MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address tmara272387@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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051222000373 WI Practitioner - Nurse Practitioner 6608898358 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
994WIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Dean Health Systems, Inc CurrentSince Nov 1, 2014 Accepting new patients
Integrated Wound Care Management Wisconsin LLC CurrentSince Mar 10, 2022 Accepting new patients
Dean Health Systems, Inc. CurrentSince Nov 1, 2014 Accepting new patients

Locations

492C Cedar Ln
Teaneck, NJ 07666
Phone (201) 357-5468

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

707 14th St
Baraboo, WI 53913
Phone (608) 356-1400

825 Western Ave
Columbus, WI 53925
Phone (920) 623-2520

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

Interoperability endpoints

  • Direct secure messaging: tmara272387@direct-ehr-ssmhc.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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1145404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607558400000",
    "number": "1558326967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 TUTTLE ST",
            "city": "BARABOO",
            "state": "WI",
            "postal_code": "539133319",
            "telephone_number": "608-356-2145",
            "fax_number": "608-356-2147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 TUTTLE ST",
            "city": "BARABOO",
            "state": "WI",
            "postal_code": "539133319",
            "telephone_number": "608-356-2145",
            "fax_number": "608-356-2147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARA",
        "first_name": "TRUDY",
        "middle_name": "A",
        "credential": "APNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-19",
        "last_updated": "2020-12-10",
        "certification_date": "2020-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "994",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1558326967",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tmara272387@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "tmara272387@direct-ehr-ssmhc.com",
            "address_1": "1700 Tuttle St",
            "city": "Baraboo",
            "state": "WI",
            "country_code": "US",
            "postal_code": "539133319",
            "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": "1700 Tuttle St",
            "city": "Baraboo",
            "state": "WI",
            "country_code": "US",
            "postal_code": "539133319",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Baraboo, WI

Sources for this page

Verify at the official NPI Registry.