NPIMap

Individual provider Active NPI

Mathew Patrick Herbst, MD

  • Family Medicine Physician
  • Waunakee, WI
National Provider Identifier
1811020969
Registry record updated Nov 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
66597-20 Issued in WI
Practice address
1300 S Century Ave
Waunakee, WI 53597
Phone
(608) 849-4315
Fax
(608) 850-1606
NPI assigned
Mar 14, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 66597-20 WI Primary
Physical Therapist 225100000X 10762-024 WI

Addresses

Primary practice location

1300 S Century Ave
Waunakee, WI 53597

Mailing address

1100 Delaplaine CT
Attn: Educational Services
Madison, WI 53715-1840

Other identifiers 1

IdentifierTypeStateIssuer
1811020969MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address mherbst269639@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
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180716001054 WI Practitioner - Family Practice 7911000468 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Dean Health Systems IncGroup PAC ID 7012827983, 1,174 clinicians

Practice addresses (Care Compare)

1300 S Century Ave
Waunakee, WI 53597-2386
Phone (608) 849-4315

Hospital & facility affiliations

  • SSM Health at Home Home Health-Wisconsin Home health agency, Madison, WI, CCN 527184
  • Agrace Hospicecare Hospice, Madison, WI, CCN 521505
  • SSM Health at Home Hospice Hospice, Baraboo, WI, CCN 521522
  • SSM Health St Mary'S Hospital - Madison Hospital, Madison, WI, CCN 520083
  • University of Wi Hospitals & Clinics Authority Hospital, Madison, WI, CCN 520098
  • SSM Health St Clare Hospital - Baraboo Hospital, Baraboo, WI, CCN 520057
  • Sauk Prairie Hospital Hospital, Prairie Du Sac, WI, CCN 520095

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Removal of skin lesions20
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
10762-024WIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Dean Health Systems, Inc Family Medicine CurrentSince Jun 22, 2018 Accepting new patients
Dean Health Systems, Inc. CurrentSince Jun 22, 2018 Accepting new patients

Locations

1808 W Beltline Hwy
Madison, WI 53713
Phone (608) 250-1497

515 22nd Ave
Monroe, WI 53566
Phone (608) 324-1000

1300 S Century Ave
Waunakee, WI 53597
Phone (608) 849-4315

Interoperability endpoints

  • Direct secure messaging: mherbst269639@direct-ehr-ssmhc.com

Organizations & group practices 22

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.

View all 22

Hospital & facility affiliations 7

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": "1173830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606089600000",
    "number": "1811020969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 DELAPLAINE CT",
            "address_2": "ATTN: EDUCATIONAL SERVICES",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537151840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 S CENTURY AVE",
            "city": "WAUNAKEE",
            "state": "WI",
            "postal_code": "53597",
            "telephone_number": "608-849-4315",
            "fax_number": "608-850-1606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERBST",
        "first_name": "MATHEW",
        "middle_name": "PATRICK",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-14",
        "last_updated": "2020-11-23",
        "certification_date": "2020-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "66597-20",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "10762-024",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1811020969",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mherbst269639@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "mherbst269639@direct-ehr-ssmhc.com",
            "address_1": "1300 S Century Ave",
            "city": "Waunakee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "53597",
            "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": "1300 S Century Ave",
            "city": "Waunakee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "53597",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Waunakee, WI

Sources for this page

Verify at the official NPI Registry.