NPIMap

Organization Active NPI

Philip M Marden MD SC

  • Pediatrics Physician
  • Oconomowoc, WI
National Provider Identifier
1700996576
Registry record updated Dec 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
14664 Issued in WI
Legal business name
PHILIP M MARDEN MD SC
Practice address
340 Summit Avenue
Oconomowoc, WI 53066-3747
Phone
(262) 567-0366
Fax
(262) 567-0368
NPI assigned
Aug 30, 2006
Last updated
Dec 6, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2012

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

Authorized official

Name
Philip Manuel Marden, MDNPI 1073659546
Title
President
Phone
(262) 667-0366

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207KA0200X 14664 WI
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X 14664 WI
Pediatrics PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208000000X 14664 WI Primary

Addresses

Primary practice location

340 Summit Avenue
Oconomowoc, WI 53066-3747

Mailing address

340 Summit Avenue
Oconomowoc, WI 53066-3747
Phone (262) 567-0366

Other identifiers 13

IdentifierTypeStateIssuer
AS68366510001OtherCIGNA
112760524654OtherHUMANA
31212300MedicaidWI
718112OtherMANAGED HEALTH SERVICES
14664OtherMEDICAL LICENSE
1200110OtherUNITED HEALTH CARE
52D0388538OtherCLIA CERTIFICATE
1000283OtherPHYSICIANS PLUS INSURANCE
12659OtherDEAN HEALTH PLAN
213688OtherONE HEALTH PLAN
4308968OtherAETNA
W003437OtherCHAMPUS
MARDENPHIOtherMERCYCARE HEALTH PLANS

National Provider Directory

National Provider Directory

Locations

340 Summit Ave
Oconomowoc, WI 53066
Phone (262) 567-0366

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354752000000",
    "number": "1700996576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 SUMMIT AVENUE",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530663747",
            "telephone_number": "262-567-0366",
            "fax_number": "262-567-0368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 SUMMIT AVENUE",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530663747",
            "telephone_number": "262-567-0366",
            "fax_number": "262-567-0368"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHILIP M MARDEN MD SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2012-12-06",
        "status": "A",
        "authorized_official_last_name": "MARDEN",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_middle_name": "MANUEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "262-667-0366",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207KA0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Allergy & Immunology, Allergy",
            "state": "WI",
            "license": "14664",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "14664",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "WI",
            "license": "14664",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "AS68366510001",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "112760524654",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31212300",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MANAGED HEALTH SERVICES",
            "identifier": "718112",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "14664",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "1200110",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA CERTIFICATE",
            "identifier": "52D0388538",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIANS PLUS INSURANCE",
            "identifier": "1000283",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEAN HEALTH PLAN",
            "identifier": "12659",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ONE HEALTH PLAN",
            "identifier": "213688",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4308968",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS",
            "identifier": "W003437",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MERCYCARE HEALTH PLANS",
            "identifier": "MARDENPHI",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oconomowoc, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.