NPIMap

Organization Active NPI

Prairie Ridge Health Inc.

Doing business as Prairie Ridge Health Clinic-Sun Prairie

  • Family Medicine Physician
  • Sun Prairie, WI
National Provider Identifier
1699534545
Registry record updated Mar 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PRAIRIE RIDGE HEALTH INC.
Doing business as
Prairie Ridge Health Clinic-Sun Prairie
Practice address
155 South Mallard Drive
Sun Prairie, WI 53590
Phone
(920) 623-2200
NPI assigned
Mar 14, 2024
Last updated
Mar 14, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
PRAIRIE RIDGE HEALTH, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 14, 2024

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

Authorized official

Name
Melissa Mangan
Title
Cfo
Phone
(920) 623-1369

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

155 South Mallard Drive
Sun Prairie, WI 53590

Mailing address

1515 Park Ave
Columbus, WI 53925-1618

Other names 1

  • Prairie Ridge Health Clinic-Sun Prairie Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040210000777 WI Part B Supplier - Clinic/Group Practice 6800791484 Receives reassigned benefits from 116 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Beaver Dam, WI; Columbus, WI; Marshall, WI; Sun Prairie, WI

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Prairie Ridge Health Inc7 organizations share this tax ID, including this one
Part of
Prairie Ridge Health Inc

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

134 Corporate Dr
Beaver Dam, WI 53916
Phone (920) 356-1000

155 S Mallard Dr
Sun Prairie, WI 53590
Phone (608) 834-4800

620 W Brown St
Waupun, WI 53963
Phone (920) 324-5581

Practitioners & affiliated clinicians

Practitioners 214

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 214

NPI Registry JSON

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

{
    "created_epoch": "1710374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710374400000",
    "number": "1699534545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 PARK AVE",
            "city": "COLUMBUS",
            "state": "WI",
            "postal_code": "539251618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 SOUTH MALLARD DRIVE",
            "city": "SUN PRAIRIE",
            "state": "WI",
            "postal_code": "53590",
            "telephone_number": "920-623-2200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE RIDGE HEALTH INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRAIRIE RIDGE HEALTH, INC.",
        "enumeration_date": "2024-03-14",
        "last_updated": "2024-03-14",
        "certification_date": "2024-03-13",
        "status": "A",
        "authorized_official_last_name": "MANGAN",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "920-623-1369"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prairie Ridge Health Clinic-Sun Prairie",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sun Prairie, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.