NPIMap

Individual provider Active NPI

Melissa Rose Revels, APNP

  • Adult Health Nurse Practitioner
  • Sparta, WI
National Provider Identifier
1760935043
Registry record updated Aug 3, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
148085 7120 Issued in WI
Practice address
315 W Oak St
Sparta, WI 54656-2150
Phone
(608) 269-6731
NPI assigned
Aug 3, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 148085 7120 WI Primary

Addresses

Primary practice location

315 W Oak St
Sparta, WI 54656-2150

Mailing address

1836 South Ave
La Crosse, WI 54601-5429
Phone (608) 782-7300

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
I20161006001230 WI Practitioner - Nurse Practitioner 0749578730 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Gundersen Clinic LTDGroup PAC ID 9638082779, 422 clinicians

Practice addresses (Care Compare)

1111 W Wisconsin St
Sparta, WI 54656-2233
Phone (608) 269-6731

1600 Main St
Onalaska, WI 54650-2838
Phone (608) 783-4681

402 A W Lake St
Friendship, WI 53934-9699
Phone (608) 339-8471

402 W Lake St
Friendship, WI 53934-9699
Phone (608) 339-3331

505 Gopher Dr
Tomah, WI 54660-4513
Phone (608) 372-4111

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
148085 7120WIMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Gundersen Clinic LTD CurrentSince Oct 10, 2016 Accepting new patients
Gundersen Lutheran Express Care, Inc CurrentSince Oct 10, 2016 Accepting new patients
Gundersen Clinic, LTD. Past Accepting new patients

Locations

402 W Lake St
Friendship, WI 53934
Phone (608) 339-3331

1836 South Ave
La Crosse, WI 54601
Phone (608) 788-8102

1600 Main St
Onalaska, WI 54650
Phone (608) 783-4681

315 W Oak St
Sparta, WI 54656
Phone (608) 269-6731

1111 W Wisconsin St
Sparta, WI 54656
Phone (608) 263-9531

Interoperability endpoints

  • Direct secure messaging: mrevels8075@direct.emplifyhealth.org

Organizations & group practices 3

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 11

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": "1470182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470182400000",
    "number": "1760935043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1836 SOUTH AVE",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546015429",
            "telephone_number": "608-782-7300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 W OAK ST",
            "city": "SPARTA",
            "state": "WI",
            "postal_code": "546562150",
            "telephone_number": "608-269-6731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REVELS",
        "first_name": "MELISSA",
        "middle_name": "ROSE",
        "credential": "APNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-03",
        "last_updated": "2016-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "WI",
            "license": "148085 7120",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sparta, WI

Sources for this page

Verify at the official NPI Registry.