Individual provider Active NPI

Virginia Medinilla, MD, PHD

  • Psychiatry Physician
  • Madison, WI
National Provider Identifier
1710497144
Registry record updated Sep 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
77057-20 Issued in WI
Practice address
1102 S Park St
Madison, WI 53715-1708
Phone
(608) 282-8270
NPI assigned
Oct 12, 2017
Last updated
Sep 26, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 321201 LA
Student in an Organized Health Care Education/Training Program 390200000X
Psychiatry Physician 2084P0800X 77057-20 WI Primary

Addresses

Primary practice location

1102 S Park St
Madison, WI 53715-1708

Mailing address

7974 Uw Health CT
Middleton, WI 53562-5531

Other practice location 1

1542 Tulane Ave
New Orleans, LA 70112-2865
Phone (504) 568-7912

Other identifiers 1

IdentifierTypeStateIssuer
2464981MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20231010000089 WI Practitioner - Psychiatry 4486901899 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Louisiana State University School of Medicine in New Orleans, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1102 S Park
Floors 2 and 4
Madison, WI 53715-1714
Phone (608) 287-5899

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.32 of 100Reported as group
Quality
87.78
Promoting interoperability
77
Improvement activities
40
Cost
75.8

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
321201LAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Wisconsin Medical Foundation, Inc CurrentSince Oct 2, 2023 Accepting new patients
University of Wisconsin Medical Foundation, Inc CurrentSince Oct 2, 2023 Accepting new patients
University of Wisconsin Medical Foundation Inc Past Accepting new patients
University of Wisconsin System Non Payroll Past Accepting new patients

Locations

1102 S Park St
Madison, WI 53715
Phone (608) 263-3111

1102 S Park St
#2
Madison, WI 53715
Phone (608) 287-5899

1102 S Park St
Ste 400
Madison, WI 53715
Phone (608) 282-8270

600 Highland Ave
Madison, WI 53792
Phone (608) 263-0325

6001 Research Park Blvd
Madison, WI 53719
Phone (608) 232-3171

7974 Uw Health Ct
Middleton, WI 53562
Phone (608) 829-5270

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 1

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": "1507766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695686400000",
    "number": "1710497144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7974 UW HEALTH CT",
            "city": "MIDDLETON",
            "state": "WI",
            "postal_code": "535625531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1102 S PARK ST",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537151708",
            "telephone_number": "608-282-8270"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1542 Tulane Ave",
            "address_purpose": "LOCATION",
            "city": "New Orleans",
            "state": "LA",
            "postal_code": "701122865",
            "country_code": "US",
            "telephone_number": "504-568-7912",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MEDINILLA",
        "first_name": "VIRGINIA",
        "credential": "MD, PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-12",
        "last_updated": "2023-09-26",
        "certification_date": "2023-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "LA",
            "license": "321201",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WI",
            "license": "77057-20",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2464981",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

Verify at the official NPI Registry.