NPIMap

Organization Active NPI

Wildwood Family Clinic SC

  • Family Medicine Physician
  • Madison, WI
National Provider Identifier
1851300784
Registry record updated Jan 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
WILDWOOD FAMILY CLINIC SC
Practice address
4901 Cottage Grove Rd
Madison, WI 53716-1392
Phone
(608) 221-1501
Fax
(608) 223-3540
NPI assigned
Aug 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2008

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

Authorized official

Name
Sheryl Green
Title
Administrator
Phone
(608) 221-1501

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

4901 Cottage Grove Rd
Madison, WI 53716-1392

Mailing address

4901 Cottage Grove Rd
Madison, WI 53716-1392
Phone (608) 221-1501

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040920000493 WI Part B Supplier - Clinic/Group Practice 9537137484 Receives reassigned benefits from 31 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Madison, WI

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
52D0393727Wildwood Family Clinic4901 Cottage Grove Rd, Madison, WI 53716ComplianceMay 27, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 22

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200355200000",
    "number": "1851300784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4901 COTTAGE GROVE RD",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537161392",
            "telephone_number": "608-221-1501",
            "fax_number": "608-223-3540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4901 COTTAGE GROVE RD",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537161392",
            "telephone_number": "608-221-1501",
            "fax_number": "608-223-3540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILDWOOD FAMILY CLINIC SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-07",
        "last_updated": "2008-01-15",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "SHERYL",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "608-221-1501"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "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 Jan 15, 2008; 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.

Verify at the official NPI Registry.