Individual provider Active NPI

Mara Leone Williams, PA-C

  • Physician Assistant
  • Madison, WI
National Provider Identifier
1770952095
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5858 Issued in WI
Practice address
8025 Excelsior Dr
#110
Madison, WI 53717-1900
Phone
(608) 663-6154
NPI assigned
Sep 16, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X
Physician Assistant 363A00000X 5858 WI Primary

Addresses

Primary practice location

8025 Excelsior Dr
#110
Madison, WI 53717-1900

Mailing address

2840 Index Rd
Fitchburg, WI 53713-3117
Phone (608) 440-1682

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221007000546 WI Practitioner - Physician Assistant 3274919683 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Wisconsin School of Medicine, 2022
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)

436 Sunrise Dr
Spring Green, WI 53588-9286
Phone (608) 588-2502

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
Physician Assistant

State licenses

LicenseStateTypeSpecialty
5858WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Sauk Prairie Healthcare Inc Current Accepting new patients
Sauk Prairie Healthcare, Inc. CurrentSince Jan 29, 2024 Accepting new patients
The Family Center Marriage & Family Therapist Past Accepting new patients
Sauk Prairie Healthcare Inc Past Accepting new patients

Locations

160 Valley Dr
Lodi, WI 53555
Phone (608) 592-3296

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

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

260 26th St
Prairie du Sac, WI 53578
Phone (608) 643-2471

250 26th St
Prairie du Sac, WI 53578
Phone (608) 643-2431

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/

Organizations & group practices 6

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 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": "1442361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1770952095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2840 INDEX RD",
            "city": "FITCHBURG",
            "state": "WI",
            "postal_code": "537133117",
            "telephone_number": "608-440-1682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8025 EXCELSIOR DR",
            "address_2": "#110",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537171900",
            "telephone_number": "608-663-6154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "MARA",
        "middle_name": "LEONE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-16",
        "last_updated": "2022-07-21",
        "certification_date": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "5858",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

Verify at the official NPI Registry.