Charles James Hodulik, MD
Individual provider Active NPI Psychiatry Physician · Madison, WI
NPI 1770517898 · NPPES record last updated Apr 12, 2012
Key facts
- NPI
- 1770517898
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatry Physician 2084P0800X
- License
- 22400-020 (WI)
- Practice address
- 2727 Marshall CT
Psychiatric Services, SC
Madison, WI 53705-2255 - Phone
- (608) 238-9354
- Fax
- (608) 238-7675
- NPI assigned
- Jul 11, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Psychiatry
- Education
- University of Wisconsin School of Medicine, 1976
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Northland Community Services Inc.
Psychiatric Services SC
Practice addresses (Care Compare)
161 Spring St
Westfield, WI 53964-9068
Phone (608) 296-2139
161 Spring St
PO Box 248
Westfield, WI 53964-0248
2727 Marshall CT
Madison, WI 53705-2255
Phone (608) 238-9354
PO Box
Suite 248
Westfield, WI 53964-0248
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040121001120 | WI | Practitioner - Psychiatry | 1254233224 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22400-020 | WI | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northland Community Services Inc | Current |
Accepting new patients | |
| Psychiatric Services SC | Psychiatry | Current |
Accepting new patients |
| Northland Community Services Inc | Past | Accepting new patients |
Locations
2727 Marshall Ct
Madison, WI 53705
Phone (608) 238-9354
161 Spring St
Westfield, WI 53964
Phone (608) 296-2139
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 22400-020 | WI | Yes |
Addresses
Primary practice location
2727 Marshall CT
Psychiatric Services, SC
Madison, WI 53705-2255
Mailing address
2727 Marshall CT
Madison, WI 53705-2255
Phone (608) 238-9354
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 22400-020 | Other | WI | WI PHYSICIANS LICENSE 3 |
Other providers in Madison, WI
- Relayia Hodges
- Kathleen Ann Hodgkins
- Samantha Lynn Hodgman
- Allison Hodgson
- Alan Hodkiewicz
- Brian David Hoefer
- Daniel J. Hoefer
- Anne K Hoeft
- Anne V Hoeft
- Mark J Hoel
All providers in Madison, WI · Psychiatry Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 12, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.