NPIMap

Individual provider Active NPI

Jeffrey M Collins

  • Family Medicine Physician
  • Plain, WI
National Provider Identifier
1710953583
Registry record updated Mar 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
40101 Issued in WI
Practice address
825 Main St
Plain, WI 53577-9668
Phone
(608) 546-4211
NPI assigned
Feb 23, 2006
Last updated
Mar 24, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 40101 WI Primary

Addresses

Primary practice location

825 Main St
Plain, WI 53577-9668

Mailing address

825 Main St
Plain, WI 53577-9668
Phone (608) 546-4211

Other identifiers 2

IdentifierTypeStateIssuer
32603600MedicaidWI
080155015OtherWIRAILROAD MEDICARE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address saukprairie@directclinics.saukprairiehealthcare.org

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
I20091028000642 WI Practitioner - Family Practice 0749327484 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Wisconsin School of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sauk Prairie Healthcare IncGroup PAC ID 8224948054, 122 clinicians

Practice addresses (Care Compare)

825 Main St
Plain, WI 53577-9668
Phone (608) 546-4211

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Sauk Prairie Healthcare Inc Family Medicine CurrentSince Jan 1, 2016 Accepting new patients
Sauk Prairie Healthcare, Inc. Family Medicine CurrentSince Jan 1, 2016 Accepting new patients
Sauk Prairie Healthcare Inc Current Accepting new patients
Sauk Prairie Healthcare Inc Family Medicine Past Accepting new patients

Locations

506 Crocker St
Ste 3
Mazomanie, WI 53560
Phone (608) 795-4110

825 Main St
Plain, WI 53577
Phone (608) 546-4211

436 Sunrise Dr
Spring Green, WI 53588
Phone (608) 588-2502

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: jeffrey.collins@direct.saukprairiehealthcare.org

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 8

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": "1140652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616544000000",
    "number": "1710953583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 MAIN ST",
            "city": "PLAIN",
            "state": "WI",
            "postal_code": "535779668",
            "telephone_number": "608-546-4211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 MAIN ST",
            "city": "PLAIN",
            "state": "WI",
            "postal_code": "535779668",
            "telephone_number": "608-546-4211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLLINS",
        "first_name": "JEFFREY",
        "middle_name": "M",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-23",
        "last_updated": "2021-03-24",
        "certification_date": "2021-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "40101",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32603600",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080155015",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "saukprairie@directclinics.saukprairiehealthcare.org",
            "affiliation": "N",
            "address_1": "825 Main St",
            "city": "Plain",
            "state": "WI",
            "country_code": "US",
            "postal_code": "535779668",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Plain, WI

Sources for this page

Verify at the official NPI Registry.