NPIMap

Individual provider Active NPI

Mark L Goelzer, MD

  • Pediatrics Physician
  • Janesville, WI
National Provider Identifier
1619902111
Registry record updated Sep 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
21490-20 Issued in WI
Practice address
3524 E Milwaukee St
Janesville, WI 53546-1626
Phone
(608) 756-7100
Fax
(608) 756-4700
NPI assigned
Jul 12, 2006
Sex
Male
Sole proprietor
No

Organizations & group practices 14

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.

View all 14

Owned or controlled facilities with NPI records 13

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

View all 13

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
University of Wisconsin School of Medicine, 1973
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Health System Corporation 749 clinicians

Practice addresses (Care Compare)

1000 Mineral Point Ave
Janesville, WI 53548-2940
Phone (608) 756-6508

3524 E Milwaukee St
Janesville, WI 53546-1626
Phone (608) 756-7100

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
I20040302000864 WI Practitioner - Pediatric Medicine 7416860382 Reassigns benefits to 1 organization

All facility ownership & control disclosures 13

Medicare enrollment files

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

FacilityTypeRoleSince
Mercyhealth FHN HospitalFreeport, IL, CCN 140160 Hospital Corporate Director Sep 22, 1988
Mercy Hospital JanesvilleJanesville, WI, CCN 520066 Hospital Corporate Officer
Corporate Director
W-2 Managing Employee		 Jan 1, 2016
Oct 27, 2008
Jan 1, 2016
Mercy Harvard HospitalHarvard, IL, CCN 141335 Hospital Corporate Officer
Corporate Director
W-2 Managing Employee		 Aug 1, 2016
Jul 4, 2004
Jan 1, 2016
Javon Bea HospitalRockford, IL, CCN 140239 Hospital Corporate Officer
Corporate Director
W-2 Managing Employee		 Jan 1, 2016
Jan 1, 2016
Jan 1, 2016
Mercy Walworth Hospital & Medical CenterLake Geneva, WI, CCN 521357 Hospital Corporate Officer
Corporate Director
W-2 Managing Employee		 Jan 1, 2016
Nov 14, 2005
Jan 1, 2016
Mercyhealth Hospital and Physician Clinic-Crystal LakeCrystal Lake, IL, CCN 140308 Hospital Corporate Officer
Corporate Director		 Jan 1, 2016
Jan 1, 2016
Mercy Harvard Care CenterHarvard, IL, CCN 146014 Skilled nursing facility Corporate Officer
Corporate Director		 Jan 1, 2016
Jan 1, 2016
Mercy Manor Transition CenterJanesville, WI, CCN 525666 Skilled nursing facility Corporate Officer
Corporate Director
Operational/Managerial Control
Adp of the SNF		 Jan 1, 2016
Sep 22, 1988
Sep 22, 1988
May 7, 2025
Mercyhealth Javon Bea Hospital Sub-Acute UnitRockford, IL, CCN 146196 Skilled nursing facility Corporate Officer
Corporate Director		 Jan 1, 2016
Jan 1, 2016
Mercyhealth at HomeJanesville, WI, CCN 527018 Home health agency Corporate Officer (100%)
Corporate Director
W-2 Managing Employee (100%)		 Jan 1, 2016
Jan 1, 2016
Jan 1, 2016
Mercyhealth at HomeRockford, IL, CCN 147029 Home health agency Corporate Officer
Corporate Director		 Jan 1, 2016
Sep 1, 2016
Mercyhealth at HomeJanesville, WI, CCN 521550 Hospice Corporate Officer
Corporate Director
W-2 Managing Employee		 Jan 1, 2016
Jan 1, 2016
Jan 1, 2016
Vna HospiceRockford, IL, CCN 141521 Hospice Corporate Officer
Corporate Director		 Jan 1, 2016
Jan 1, 2015

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
21490-20WIMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health System Corporation CurrentSince Aug 1, 1997 Accepting new patients
Mercy Health System Corporation CurrentSince Aug 1, 1997 Accepting new patients
Mercy Health System Corporation Current Accepting new patients
Mercy Health System Corporation Past Accepting new patients

Locations

29624 Network Pl
Chicago, IL 60673
Phone (608) 741-7652

1000 Mineral Point Ave
Janesville, WI 53548
Phone (608) 261-6868

3524 E Milwaukee St
Janesville, WI 53546
Phone (608) 756-7100

Interoperability endpoints

  • Direct secure messaging: mgoelzer3287@direct.mhemail.org

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 21490-20 WI Primary

Addresses

NPPES NPI Registry

Primary practice location

3524 E Milwaukee St
Janesville, WI 53546-1626

Mailing address

3524 E Milwaukee St
Janesville, WI 53546-1626
Phone (608) 756-7100

Other identifiers 3

NPPES NPI Registry
IdentifierTypeStateIssuer
30170700MedicaidWI
1619902111MedicaidWI
GOELZMAROtherWIMERCYCARE INSURANCE

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 23, 2014.

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1411430400000",
    "number": "1619902111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3524 E MILWAUKEE ST",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535461626",
            "telephone_number": "608-756-7100",
            "fax_number": "608-756-4700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3524 E MILWAUKEE ST",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535461626",
            "telephone_number": "608-756-7100",
            "fax_number": "608-756-4700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOELZER",
        "first_name": "MARK",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-12",
        "last_updated": "2014-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WI",
            "license": "21490-20",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30170700",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1619902111",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MERCYCARE INSURANCE",
            "identifier": "GOELZMAR",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Janesville, WI

Sources for this page

Verify at the official NPI Registry.