Individual provider Active NPI

Maria Andres, PA-C

  • Physician Assistant
  • Sauk City, WI
National Provider Identifier
1841398435
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1727 Issued in WI
Practice address
112 Helen St
Sauk City, WI 53583-1101
Phone
(608) 643-3351
Fax
(608) 643-3621
NPI assigned
Sep 20, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1727 WI Primary

Addresses

Primary practice location

112 Helen St
Sauk City, WI 53583-1101

Mailing address

112 Helen St
Sauk City, WI 53583-1101
Phone (608) 643-3351

Other identifiers 1

IdentifierTypeStateIssuer
41988800MedicaidWI

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
I20040910001076 WI Practitioner - Physician Assistant 5193792000 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
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)

112 Helen St
Sauk City, WI 53583-1101
Phone (608) 643-3351

260 26TH St
Prairie Du Sac, WI 53578-2203
Phone (608) 643-7574

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1727WIMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Sauk Prairie Healthcare Inc Current Accepting new patients
Sauk Prairie Healthcare Inc Past Accepting new patients

Locations

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

Interoperability endpoints

  • Direct secure messaging: maria.andres@direct.prairieclinic.nextgenshare.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1841398435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 HELEN ST",
            "city": "SAUK CITY",
            "state": "WI",
            "postal_code": "535831101",
            "telephone_number": "608-643-3351",
            "fax_number": "608-643-3621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 HELEN ST",
            "city": "SAUK CITY",
            "state": "WI",
            "postal_code": "535831101",
            "telephone_number": "608-643-3351",
            "fax_number": "608-643-3621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDRES",
        "first_name": "MARIA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "1727",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41988800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sauk City, WI

Sources for this page

Verify at the official NPI Registry.