NPIMap

Individual provider Active NPI

Mark G Timmerman, MD

  • Sports Medicine (Family Medicine) Physician
  • Spring Green, WI
National Provider Identifier
1881649333
Registry record updated Apr 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
License
31402-020 Issued in WI
Practice address
436 Sunrise Dr
Spring Green, WI 53588-9286
Phone
(608) 588-2502
Fax
(608) 588-7724
NPI assigned
May 23, 2006
Last updated
Apr 29, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2008

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 31402-020 WI
Sports Medicine (Family Medicine) Physician 207QS0010X 31402-020 WI Primary

Addresses

Primary practice location

436 Sunrise Dr
Spring Green, WI 53588-9286

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
31648300MedicaidWI
P00463755OtherWIRAILROAD MEDICARE

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
I20061204000250 WI Practitioner - Family Practice 4981603818 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Mayo Medical School, 1989
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

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
31402-020WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sauk Prairie Healthcare, Inc. Family Medicine CurrentSince Nov 15, 2006 Accepting new patients
Sauk Prairie Healthcare Inc Family Medicine CurrentSince Nov 15, 2006 Accepting new patients
Sauk Prairie Healthcare Inc Current 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

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

80 1st St
Prairie du Sac, WI 53578
Phone (608) 643-3311

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/
  • Direct secure messaging: mark.timmerman@direct.saukprairiehealthcare.org

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 12

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": "1148342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209427200000",
    "number": "1881649333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "436 SUNRISE DR",
            "city": "SPRING GREEN",
            "state": "WI",
            "postal_code": "535889286",
            "telephone_number": "608-588-2502",
            "fax_number": "608-588-7724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "436 SUNRISE DR",
            "city": "SPRING GREEN",
            "state": "WI",
            "postal_code": "535889286",
            "telephone_number": "608-588-2502",
            "fax_number": "608-588-7724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIMMERMAN",
        "first_name": "MARK",
        "middle_name": "G",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-23",
        "last_updated": "2008-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "31402-020",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "WI",
            "license": "31402-020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31648300",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00463755",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Spring Green, WI

Sources for this page

Verify at the official NPI Registry.