Active NPI
Molly Rebecca Ide, CRNA
- Certified Registered Nurse Anesthetist
- Madison, WI
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 14096
- Practice address
- 700 S Park St
Madison, WI 53715-1830 - Phone
- (608) 251-6000
- Fax
- (608) 258-5222
- NPI assigned
- Jun 22, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 14096 | WI | Primary |
Addresses
Primary practice location
700 S Park St
Madison, WI 53715-1830
Mailing address
4620 Frey St Apt 327
Madison, WI 53705-2903
Phone (608) 577-5563
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831875251 | Medicaid | WI |
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | mide489413@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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
700 S Park St
Madison, WI 53715-1830
Phone (608) 251-6100
Hospital & facility affiliations
- SSM Health St Mary'S Hospital - Madison
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14096 | WI | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dean Health Systems, Inc | Current | Accepting new patients | |
| Dean Health Systems, Inc. | Current | Accepting new patients |
Locations
1808 W Beltline Hwy
Madison, WI 53713
Phone (608) 250-1497
700 S Park St
Madison, WI 53715
Phone (608) 260-2900
515 22nd Ave
Monroe, WI 53566
Phone (608) 324-1000
Organizations & group practices 2
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.
-
- Allergy & Immunology Physician
- Madison, WI
- NPI 1053358846
-
- Durable Medical Equipment & Medical Supplies
- Portage, WI
- NPI 1427085679
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Madison, WI
- NPI 1184621211
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1687392000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1693353600000",
"number": "1831875251",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4620 FREY ST APT 327",
"city": "MADISON",
"state": "WI",
"postal_code": "537052903",
"telephone_number": "608-577-5563"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 S PARK ST",
"city": "MADISON",
"state": "WI",
"postal_code": "537151830",
"telephone_number": "608-251-6000",
"fax_number": "608-258-5222"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IDE",
"first_name": "MOLLY",
"middle_name": "REBECCA",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-06-22",
"last_updated": "2023-08-30",
"certification_date": "2023-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "WI",
"license": "14096",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1831875251",
"state": "WI"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "mide489413@direct-ehr-ssmhc.com",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "mide489413@direct-ehr-ssmhc.com",
"address_1": "700 S Park St",
"city": "Madison",
"state": "WI",
"country_code": "US",
"postal_code": "537151830",
"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": "700 S Park St",
"city": "Madison",
"state": "WI",
"country_code": "US",
"postal_code": "537151830",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Madison, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.