Individual provider Active NPI

Amy Tora Vidalin, MD

  • Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
  • Madison, WI
National Provider Identifier
1679140917
Registry record updated Jun 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) PhysicianTaxonomy code 207VF0040X
License
85724-20 Issued in WI
Practice address
600 Highland Ave
Madison, WI 53792-0004
Phone
(227) 370-6721
NPI assigned
Jun 7, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 24, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 12858 GA
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician 207VF0040X 85724-20 WI Primary

Addresses

Primary practice location

600 Highland Ave
Madison, WI 53792-0004

Mailing address

600 Highland Ave
Madison, WI 53792-0001

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20210805000477 GA Order and Referring Only - Obstetrics/GynecologyPractitioner - Obstetrics/Gynecology 4880098367

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
12858GAMDAssistant Behavior Analyst
85724-20WIMDFemale Pelvic Medicine and Reconstructive Surgery (Obstetrics & Gynecology) Physician

NPI Registry JSON

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

{
    "created_epoch": "1623024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750723200000",
    "number": "1679140917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 HIGHLAND AVE",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537920001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 HIGHLAND AVE",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537920004",
            "telephone_number": "227-370-6721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIDALIN",
        "first_name": "AMY",
        "middle_name": "TORA",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-06-07",
        "last_updated": "2025-06-24",
        "certification_date": "2025-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "GA",
            "license": "12858",
            "primary": false
        },
        {
            "code": "207VF0040X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery",
            "state": "WI",
            "license": "85724-20",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

Verify at the official NPI Registry.