Colab Physicians, SC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

COLAB PHYSICIANS, SC

Practice address

10325 N Port Washington Rd Ste 150
Mequon, WI 53092-5768

Phone

(262) 643-4720

Fax

(262) 643-4720

NPI assigned

Mar 19, 2024

Last updated

Mar 19, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mark W Niedfeldt, MDNPI 1205887775

Title

President

Phone

(262) 643-4720

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

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

CLIA laboratory certificates

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mark W Niedfeldt, MD

  • Family Medicine Physician
  • Mequon, WI
  • NPI 1205887775
  Medicare reassignment Care Compare group NPD Authorized official
• Jessica Erin Furey, DO

  • Family Medicine Physician
  • Elkhorn, WI
  • NPI 1811334501
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1710806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710806400000",
    "number": "1902666035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6400 INDUSTRIAL LOOP",
            "city": "GREENDALE",
            "state": "WI",
            "postal_code": "531292452",
            "telephone_number": "414-858-4106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10325 N PORT WASHINGTON RD STE 150",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530925768",
            "telephone_number": "262-643-4720",
            "fax_number": "262-643-4720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLAB PHYSICIANS, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-19",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A",
        "authorized_official_last_name": "NIEDFELDT",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "262-643-4720",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• City of Mequon
• Lynn Marie Clark, RD
• Kara Claussner
• Tierra Lashawn Clifton
• Tiera Virginia Cobbs
• Madalynn Collins
• Columbia Center, Inc.
• Columbia St Mary's Hospital Ozaukee, Inc. (Ascension Columbia St Mary's Hospital Ozaukee)
• Columbia St Mary's Hospital Ozaukee, Inc. (Ascension Columbia St Mary's Hospital Ozaukee)
• Columbia St Mary's Hospital Ozaukee, Inc. (Ascension Columbia St Mary's Hospital Ozaukee)

• Family Medicine Physician in Mequon, WI
• Providers in Mequon, WI by specialty
• Family Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2024; 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.