NPIMap

Individual provider Active NPI

Robert M Gullberg, MD

  • Infectious Disease Physician
  • Racine, WI
National Provider Identifier
1669402541
Registry record updated Jun 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
License
27459 Issued in WI
Practice address
3811 Spring Street
Racine, WI 53405
Phone
(262) 687-8310
Fax
(262) 687-8318
NPI assigned
Jul 4, 2006
Last updated
Jun 18, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 27459 WI
Infectious Disease Physician 207RI0200X 27459 WI Primary

Addresses

Primary practice location

3811 Spring Street
Racine, WI 53405

Mailing address

3811 Spring Street
Suite 301
Racine, WI 53405-1667
Phone (262) 687-8310

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
I20070320000376 WI Practitioner - Infectious DiseasePractitioner - Internal Medicine 1355444928 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Infectious DiseaseAlso: Internal Medicine
Education
Other, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

3803 Spring St
Mount Pleasant, WI 53405-1660
Phone (262) 687-8260

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as apm

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
27459WIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeview Neurorehab Center Midwest, Inc CurrentSince Oct 29, 2014 Accepting new patients
Lakeview Neurorehab Center Midwest, Inc CurrentSince Oct 29, 2014 Accepting new patients
Ascension Medical Group-Southeast Wisconsin Inc Internal Medicine CurrentSince Apr 2, 2007 Accepting new patients
Ascension All Saints Hospital, Inc Past Accepting new patients

Locations

13950 W Capitol Dr
Brookfield, WI 53005
Phone (414) 302-5400

3803 Spring St
Mount Pleasant, WI 53405
Phone (262) 687-4201

3811 Spring St
Mount Pleasant, WI 53405
Phone (262) 687-1600

3811 Spring St
Ste 301
Mount Pleasant, WI 53405
Phone (262) 687-6260

1701 Sharp Rd
Waterford, WI 53185
Phone (262) 534-7297

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1151971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529280000000",
    "number": "1669402541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3811 SPRING STREET",
            "address_2": "SUITE 301",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534051667",
            "telephone_number": "262-687-8310",
            "fax_number": "262-687-8318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3811 SPRING STREET",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "53405",
            "telephone_number": "262-687-8310",
            "fax_number": "262-687-8318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GULLBERG",
        "first_name": "ROBERT",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-04",
        "last_updated": "2018-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "27459",
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "WI",
            "license": "27459",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Racine, WI

Sources for this page

Verify at the official NPI Registry.