NPIMap

Individual provider Active NPI

Michael C Stark, DO

  • Family Medicine Physician
  • Tomah, WI
National Provider Identifier
1649260779
Registry record updated Sep 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
22938 Issued in WI
Practice address
325 Butts Ave
Tomah, WI 54660-1412
Phone
(608) 372-5951
Fax
(608) 372-3436
NPI assigned
Oct 28, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 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 22938 WI Primary

Addresses

Primary practice location

325 Butts Ave
Tomah, WI 54660-1412

Mailing address

PO Box 1510
Eau Claire, WI 54702-1510
Phone (608) 785-0940

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mstark27367@ehrdirect.mayoclinicmsg.org

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
I20100625000448 WI Practitioner - Family Practice 0143351734 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

800 E Blackhawk Ave
Prairie Du Chien, WI 53821-1698
Phone (608) 326-0808

800 W Ave S
La Crosse, WI 54601-8806
Phone (608) 785-0940

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
22938WIMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Mayo Clinic Health System-Southwest Wisconsin Region, Inc. CurrentSince Jan 1, 1997 Accepting new patients
Tomah Memorial Hospital Inc CurrentSince Dec 1, 2025 Accepting new patients
Tomah Memorial Hospital Inc CurrentSince Aug 1, 2013 Accepting new patients
Tomah Memorial Hospital Inc CurrentSince Aug 1, 2013 Accepting new patients
Mayo Clinic Health System-Southwest Wisconsin Region, Inc. CurrentSince Jan 1, 1997 Accepting new patients

Locations

700 West Ave S
La Crosse, WI 54601
Phone (608) 791-4156

800 West Ave S
La Crosse, WI 54601
Phone (608) 372-5951

800 E Blackhawk Ave
Prairie du Chien, WI 53821
Phone (608) 326-0808

310 W Main St
Sparta, WI 54656
Phone (608) 269-1700

501 Gopher Dr
Tomah, WI 54660
Phone (608) 371-2181

325 Butts Ave
Tomah, WI 54660
Phone (608) 372-5951

Interoperability endpoints

  • Direct secure messaging: mstark636541@direct.emplifyhealth.org
  • Direct secure messaging: mstark27367@ehrdirect.mayoclinicmsg.org

Organizations & group practices 5

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 7

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": "1130457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600214400000",
    "number": "1649260779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1510",
            "city": "EAU CLAIRE",
            "state": "WI",
            "postal_code": "547021510",
            "telephone_number": "608-785-0940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 BUTTS AVE",
            "city": "TOMAH",
            "state": "WI",
            "postal_code": "546601412",
            "telephone_number": "608-372-5951",
            "fax_number": "608-372-3436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STARK",
        "first_name": "MICHAEL",
        "middle_name": "C",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-28",
        "last_updated": "2020-09-16",
        "certification_date": "2020-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "22938",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mstark27367@ehrdirect.mayoclinicmsg.org",
            "affiliation": "N",
            "address_1": "325 Butts Ave",
            "city": "Tomah",
            "state": "WI",
            "country_code": "US",
            "postal_code": "546601412",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Tomah, WI

Sources for this page

Verify at the official NPI Registry.