Individual provider Active NPI

Alexandra Ilkevitch, M.D.

  • Physical Medicine & Rehabilitation Physician
  • Madison, WI
National Provider Identifier
1750686648
Registry record updated Nov 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
56663-20 Issued in WI
Practice address
4901 Cottage Grove Rd
Madison, WI 53716-1392
Phone
(608) 221-1505
NPI assigned
Jan 24, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 56663-20 WI Primary

Addresses

Primary practice location

4901 Cottage Grove Rd
Madison, WI 53716-1392

Mailing address

4901 Cottage Grove Rd
Madison, WI 53716-1392

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address ailkevitch260644@direct-ehr-ssmhc.com Direct
FHIR URL https//fhir.ssmhc.com/fhir/api/FHIR/DSTU2 Other

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
I20140630001644 WI Practitioner - Physical Medicine and Rehabilitation 7517190424 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Rush Medical College of Rush University, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wildwood Family Clinic SCGroup PAC ID 9537137484, 27 clinicians

Practice addresses (Care Compare)

4901 Cottage Grove Rd
Madison, WI 53716-1392
Phone (608) 221-1501

Hospital & facility affiliations

  • Stoughton Hospital Hospital, Stoughton, WI, CCN 521343
  • University of Wi Hospitals & Clinics Authority Hospital, Madison, WI, CCN 520098

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
56663-20WIMDPhysical Medicine & Rehabilitation Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wildwood Family Clinic, SC Current Accepting new patients

Locations

4901 Cottage Grove Rd
Madison, WI 53716
Phone (608) 221-1501

Interoperability endpoints

  • Direct secure messaging: ailkevitch260644@direct-ehr-ssmhc.com

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

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": "1295827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604275200000",
    "number": "1750686648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4901 COTTAGE GROVE RD",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537161392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4901 COTTAGE GROVE RD",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537161392",
            "telephone_number": "608-221-1505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ILKEVITCH",
        "first_name": "ALEXANDRA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-24",
        "last_updated": "2020-11-02",
        "certification_date": "2020-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "WI",
            "license": "56663-20",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ailkevitch260644@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "ailkevitch260644@direct-ehr-ssmhc.com",
            "address_1": "4901 Cottage Grove Rd",
            "city": "Madison",
            "state": "WI",
            "country_code": "US",
            "postal_code": "537161392",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https//fhir.ssmhc.com/fhir/api/FHIR/DSTU2",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "4901 Cottage Grove Rd",
            "city": "Madison",
            "state": "WI",
            "country_code": "US",
            "postal_code": "537161392",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

Verify at the official NPI Registry.