Michael A Mahan, M.D.
Individual provider Active NPI Family Medicine Physician · Black River Falls, WI
NPI 1922038892 · NPPES record last updated Jun 30, 2025
Key facts
- NPI
- 1922038892
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 29474 (WI)
- Practice address
- 610 W Adams St
Black River Falls, WI 54615-9010 - Phone
- (715) 284-4311
- Fax
- (715) 284-2568
- NPI assigned
- Jul 4, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 2
Owned or controlled facilities with NPI records 1
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Indiana University School of Medicine, 1987
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Black River Health Inc
Practice addresses (Care Compare)
711 W Adams St
Black River Falls, WI 54615-5052
Phone (715) 284-5361
Hospital & facility affiliations
- St Croix Hospice Eau Claire
- Black River Memorial Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 89.18 of 100
- Quality
- 87.29
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 65.34
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Meadowbrook at Black River Falls |
Skilled nursing facility | Operational/Managerial Control Adp of the SNF |
Jan 23, 1997 Jan 23, 1997 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100109000059 | WI | Practitioner - Family Practice |
0446151898 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Black River Health Inc | Current |
Accepting new patients | |
| Black River Health Inc | Current |
Accepting new patients | |
| Krohn Clinic LTD. | Family Medicine | Current |
Accepting new patients |
Locations
610 W Adams St
Blk River Fls, WI 54615
Phone (715) 284-4311
711 W Adams St
Blk River Fls, WI 54615
Phone (715) 284-1302
Interoperability endpoints
- michael.mahan@kcld.eclinicaldirectplus.com
- https://fhir4.healow.com/fhir/r4/BHJBDA
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 29474 | WI | Yes |
Addresses
Primary practice location
610 W Adams St
Black River Falls, WI 54615-9010
Mailing address
610 W Adams St
Black River Falls, WI 54615-9010
Phone (715) 284-4311
Other practice location 1
711 W Adams St
Black River Falls, WI 54615-5052
Phone (715) 284-5361
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 31555800 | Medicaid | WI |
NPI Registry JSON
{
"created_epoch": "1151971200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1751241600000",
"number": "1922038892",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "610 W ADAMS ST",
"city": "BLACK RIVER FALLS",
"state": "WI",
"postal_code": "546159010",
"telephone_number": "715-284-4311",
"fax_number": "715-284-2568"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "610 W ADAMS ST",
"city": "BLACK RIVER FALLS",
"state": "WI",
"postal_code": "546159010",
"telephone_number": "715-284-4311",
"fax_number": "715-284-2568"
}
],
"practiceLocations": [
{
"address_1": "711 W Adams St",
"address_purpose": "LOCATION",
"city": "Black River Falls",
"state": "WI",
"postal_code": "546155052",
"country_code": "US",
"telephone_number": "715-284-5361",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MAHAN",
"first_name": "MICHAEL",
"middle_name": "A",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-04",
"last_updated": "2025-06-30",
"certification_date": "2025-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WI",
"license": "29474",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "31555800",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Black River Falls, WI
- Pamela Listle
- Amy Kay Littlegeorge
- Hera Jane Lonetree-Rindahl
- LT Resources
- Rachel Marie Lundberg
- Making Meaning LLC
- Jesse L Mann
- Carol A Martin
- Amy McCarthy
- Katrina K McGillivray
All providers in Black River Falls, WI · Family Medicine Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 30, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.