CARMEN M CAMPBELL M.D.
NPI 1124252887
Internal Medicine - Rheumatology in Madison, WI

Active since May 11, 2009PECOS EnrolledAccepts Medicare Assignment
77.43/100
CMS Quality Rating
451 JUNCTION RD, MADISON, WI 53717(608) 263-7577(608) 262-3735 Get Directions Write a Review

NPPES record last updated: September 2, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Sep 2, 2022, Feb 19, 2016 (2 updates tracked since 2016).

About Carmen M Campbell M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CARMEN M CAMPBELL M.D. (NPI 1124252887) is an individual rheumatology provider in Madison, Wisconsin, licensed in Wisconsin (55401-20) and active in the NPI registry since May 2009. She is enrolled in Medicare PECOS, is affiliated with Uw Health, and is a graduate of Other (2009).

NPPES Registry Identity

NPI1124252887
Entity TypeIndividualFemale
Primary Taxonomy207RR0500X
Provider Legal NameCARMEN M CAMPBELLCredential: M.D.
Location Address451 JUNCTION RDMadison, WI 53717-2656
Mailing Address7974 Uw Health CtMiddleton, WI 53562-5531
Fax(608) 262-3735
Sole ProprietorNo
Medical School CMSOtherGraduated 2009
Enumeration DateMay 11, 2009
Last NPPES UpdateSeptember 2, 20222 updates tracked since enumeration
NPPES CertifiedSeptember 2, 2022
NPI 1124252887 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyInternal Medicine · RheumatologyAllopathic & Osteopathic Physicians
Taxonomy Code207RR0500X
License Licensed in WI · 55401-20
Definition
An internist who treats diseases of joints, muscle, bones and tendons. This specialist diagnoses and treats arthritis, back pain, muscle strains, common athletic injuries and collagen diseases.
451 JUNCTION RD, Madison, WI 53717

Accepted Insurance

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Carmen M Campbell M.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID9335372465
PECOS Enrollment IDI20220909000894
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 10

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
108 services81 patients
Insertion of needle into vein for collection of blood sample 36415
This procedure involves inserting a small needle into a vein, typically in your arm, to collect a blood sample. It's a quick and simple process to help diagnose or monitor health conditions. You may feel a small prick, but discomfort is minimal.
102 services50 patients
Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count 85025
A Complete Blood Cell Count is a common test that measures various components of the blood, including red cells (carry oxygen), white cells (fight infection), and platelets (help blood clot). An automated test ensures accuracy. The differential count provides detailed information about white cell types.
50 services26 patients
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more 99215
This service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.
45 services37 patients
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204
This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.
32 services32 patients
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes 99232
Follow-up hospital inpatient care involves daily check-ups while you're admitted in the hospital. Typically, a healthcare provider spends about 25 minutes each day reviewing your condition, adjusting treatment if needed, and answering any questions you might have.
31 services14 patients

Hospital Affiliations CMS Care Compare 3

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Uw Health

Acute Care Hospitals · Rockford, IL
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number140228
Location1401 East State StreetRockford, IL 61104 · Winnebago County
Emergency services Birthing friendly

Unitypoint Health - Meriter

Acute Care Hospitals · Madison, WI
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number520089
Location202 S Park StMadison, WI 53715 · Dane County
Emergency services Birthing friendly

University Of Wi Hospitals & Clinics Authority

Acute Care Hospitals · Madison, WI
4/5 CMS rating
OwnershipGovernment - Hospital District or Authority
CMS Certification Number520098
Location600 Highland AvenueMadison, WI 53792 · Dane County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 53717 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$123.69 typical visit price
range $53.90 – $163.24
Typical copayment $30.92 (range $13.47 – $40.81)
Most-billed visit code 99204
Established Patient
$95.41 typical visit price
range $17.40 – $133.76
Typical copayment $23.85 (range $4.35 – $33.44)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

77.43/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality81.83
Promoting Interoperability77
Improvement Activities40
Cost62.12

Reported Quality Measures

Documentation of Current Medications in the Medical Record
Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter.
100%621 patients5/55-star benchmark: 100%
Patient-Specific Education
The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician.
0%435 patients1/55-star benchmark: 100%
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan
Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous…
50%326 patients3/55-star benchmark: 97%
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received tobacco cessation intervention if identified as a tobacco user
Patients tobacco: 99% · 260 patients
100%260 patients
Provide Patient Access
At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold…
59%435 patients3/55-star benchmark: 100%
Psoriasis: Tuberculosis (TB) Prevention for Patients with Psoriasis, Psoriatic Arthritis and Rheumatoid Arthritis Patients on a Biological Immune Response Modifier
Percentage of patients whose providers are ensuring active tuberculosis prevention either through yearly negative standard tuberculosis screening tests or are reviewing the patient's history to determine if they have had appropriate management for a recent or…
100%54 patients
Rheumatoid Arthritis (RA): Assessment and Classification of Disease Prognosis
Percentage of patients aged 18 years and older with a diagnosis of rheumatoid arthritis (RA) who have an assessment and classification of disease prognosis at least once within 12 months
95%109 patients4/55-star benchmark: 100%
Rheumatoid Arthritis (RA): Functional Status Assessment
Percentage of patients aged 18 years and older with a diagnosis of rheumatoid arthritis (RA) for whom a functional status assessment was performed at least once within 12 months
100%115 patients5/55-star benchmark: 100%
Rheumatoid Arthritis (RA): Glucocorticoid Management
Percentage of patients aged 18 years and older with a diagnosis of rheumatoid arthritis (RA) who have been assessed for glucocorticoid use and, for those on prolonged doses of prednisone >= 10 mg daily (or equivalent) with improvement or no change in disease…
100%112 patients5/55-star benchmark: 100%
Rheumatoid Arthritis (RA): Periodic Assessment of Disease Activity
Percentage of patients aged 18 years and older with a diagnosis of rheumatoid arthritis (RA) who have an assessment and classification of disease activity within 12 months
100%111 patients5/55-star benchmark: 100%
Rheumatoid Arthritis (RA): Tuberculosis Screening
Percentage of patients aged 18 years and older with a diagnosis of rheumatoid arthritis (RA) who have documentation of a tuberculosis (TB) screening performed and results interpreted within 6 months prior to receiving a first course of therapy using a…
96%23 patients4/55-star benchmark: 100%
Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Physician Assistant (Medical)
451 JUNCTION RD
MADISON, WI 53717
Internal Medicine
451 JUNCTION RD
MADISON, WI 53717
Internal Medicine (Endocrinology, Diabetes & Metabolism)
451 JUNCTION RD
MADISON, WI 53717
Internal Medicine
451 JUNCTION RD
MADISON, WI 53717
Pharmacy
451 JUNCTION RD, SUITE 9901, ROOM 1191
MADISON, WI 53717
Nurse Practitioner
451 JUNCTION RD
MADISON, WI 53717
Nurse Practitioner
451 JUNCTION RD
MADISON, WI 53717
Internal Medicine
451 JUNCTION RD
MADISON, WI 53717

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Carmen Campbell's NPI number?

The NPI number for Carmen Campbell is 1124252887. It was assigned to this individual provider in the NPPES registry on May 11, 2009.

Where is Carmen Campbell located?

Carmen Campbell practices at 451 Junction Rd, Madison, WI 53717. The listed phone number is (608) 263-7577.

What is Carmen Campbell's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Rheumatology, with taxonomy code 207RR0500X.

Is Carmen Campbell enrolled in Medicare?

Yes. Carmen Campbell is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Carmen Campbell accept?

Health plans from Anthem Blue Cross and Blue Shield, Aspirus Health Plan, Group Health Cooperative-SCW, HealthPartners and Quartz and 1 other insurer list Carmen Campbell as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Carmen Campbell affiliated with any hospitals?

According to CMS data, Carmen Campbell is affiliated with Uw Health, Unitypoint Health - Meriter and University Of Wi Hospitals & Clinics Authority.

When was this NPI record last updated?

The NPPES record for Carmen Campbell was last updated on September 2, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.