Matthew Allan Mickelson
Individual provider Active NPI Family Nurse Practitioner · Deforest, WI
NPI 1942907647 · NPPES record last updated Sep 12, 2023
Key facts
- NPI
- 1942907647
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 13661-33 (WI)
- Practice address
- 4200 Savannah Dr
Deforest, WI 53532-2909 - Phone
- (608) 417-3300
- NPI assigned
- Feb 13, 2023
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 15
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Prohealth Medical Group Inc
Practice addresses (Care Compare)
N16W24131 Riverwood Dr
Waukesha, WI 53188-1106
Phone (262) 696-0808
Hospital & facility affiliations
- Waukesha Memorial Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 87.59 of 100
- Quality
- 84.57
- Promoting interoperability
- 91
- Improvement activities
- 40
- Cost
- 81.57
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: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230510000083 | WI | Practitioner - Nurse Practitioner | 2668838087 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 241314 | WI | MD | Registered Nurse |
| 13661-33 | WI | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prohealth Medical Group Inc. | Current |
Accepting new patients | |
| Meriter Hospital, Inc. | Current |
Accepting new patients | |
| Prohealth Medical Group Inc | Current |
Accepting new patients | |
| Meriter Hospital, Inc. | Current | Accepting new patients |
Locations
195 Discovery Dr
Brookfield, WI 53045
Phone (262) 513-7100
4200 Savannah Dr
Deforest, WI 53532
Phone (608) 417-3300
202 S Park St
Madison, WI 53715
Phone (608) 267-6000
3102 Meriter Way
Madison, WI 53719
Phone (608) 417-8800
808 Cornerstone Xing
Waterford, WI 53185
Phone (262) 500-5292
N16W24131 Riverwood Dr
Waukesha, WI 53188
Phone (262) 696-0696
N17W24100 Riverwood Dr
Waukesha, WI 53188
Phone (262) 820-3093
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 241314 | WI | |
| Family Nurse Practitioner | 363LF0000X | 13661-33 | WI | Yes |
Addresses
Primary practice location
4200 Savannah Dr
Deforest, WI 53532-2909
Mailing address
202 S Park St
Madison, WI 53715-1507
Phone (608) 417-6000
Other providers in Deforest, WI
- Jamie Lothe
- MCN Madison LLC
- MD Group LLC
- MD Group LLC
- Jazmine Mendez
- Erika Minkevicius
- Carol Mintz
- Macey Elizabeth Moser
- Amanda Lynn Motiff
- Neuro Connections LLC
All providers in Deforest, WI · Family Nurse Practitioner in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 12, 2023. 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.
- 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.