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DR. MATHEW POTHEN M.D.
NPI 1255505434
Family Medicine in Mount Pleasant, WI

Active since April 17, 2008PECOS Enrolled
8348 WASHINGTON AVE, MOUNT PLEASANT, WI 53406(262) 884-4000 Get Directions Write a Review

NPPES record last updated: October 23, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Dr. Mathew Pothen M.d. NPPES

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

DR. MATHEW POTHEN M.D. (NPI 1255505434) is an individual family medicine provider in Mount Pleasant, Wisconsin, licensed in Wisconsin (54995) and active in the NPI registry since April 2008. He is enrolled in Medicare PECOS and is a graduate of Other (2007).

NPPES Registry Identity

NPI1255505434
Entity TypeIndividualMale
Primary Taxonomy207Q00000X
Provider Legal NameDR. MATHEW POTHENCredential: M.D.
Location Address8348 WASHINGTON AVEMount Pleasant, WI 53406-3733
Mailing AddressPo Box 735044Chicago, IL 60673-5044 · (800) 326-2250
Phone(262) 884-4000
Sole ProprietorNo
Medical School CMSOtherGraduated 2007
Enumeration DateApril 17, 2008
Last NPPES UpdateOctober 23, 2025
NPPES CertifiedOctober 23, 2025
✔ NPI 1255505434 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in WI · 54995
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
8348 WASHINGTON AVE, Mount Pleasant, WI 53406
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Other Identifiers 1

Medicaid100015790WI

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Aspirus Health Plan, CareSource (Common Ground Healthcare), UnitedHealthcare.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Mathew Pothen M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID9335319136
PECOS Enrollment IDI20110906000338
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.

Medicare Billing Reassignments

2

Medicare enrollment records show Mathew Pothen reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Aurora Medical Group, Inc.
19 mi
Nurse Anesthetist, Certified Registered
3301 W FOREST HOME AVE
Milwaukee, WI 53215
  • Reassigned Medicare billing, Wisconsin enrollment
  • 4,609 clinicians in this Medicare group
NPI 1427271378 (877) 576-3544
Aamg Reach PLLC
71 mi
Family Medicine
1357 W 103RD ST
Chicago, IL 60643
  • Reassigned Medicare billing, Wisconsin enrollment
  • 41 clinicians in this Medicare group
NPI 1609502707 (773) 238-0800

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 8

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 low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
143 services132 patients
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.
54 services54 patients
New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more 99203
This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.
46 services46 patients
Automated urinalysis test 81003
An automated urinalysis test is a routine examination that checks your urine for various substances. It can help identify potential health issues such as kidney problems or diabetes. The test uses a machine to analyze a small urine sample, providing quick and accurate results.
23 services23 patients
Detection test by immunoassay technique for severe acute respiratory syndrome coronavirus 87426
An immunoassay test for severe acute respiratory syndrome coronavirus is a diagnostic tool. It uses your body's immune response to detect the presence of the virus. It involves taking a sample, usually from your nose or throat, which is then analyzed in a lab for signs of the virus.
19 services18 patients
Injection of drug or substance under skin or into muscle 96372
This procedure involves administering medication directly under the skin or into a muscle. A small needle is used to inject the drug, allowing it to be absorbed quickly into the bloodstream. It's a common method for delivering a variety of medications.
19 services17 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 53406 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
$82.92 typical visit price
range $53.90 – $163.24
Typical copayment $20.73 (range $13.47 – $40.81)
Most-billed visit code 99203
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.

Other Providers at the Same Location NPPES 18

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

LENORA M. BROCKMAN M.D.
Obstetrics & Gynecology
8348 WASHINGTON AVE
MOUNT PLEASANT, WI 53406
Racine County (262) 884-4000
MR. MARK LEWNO PHARM. D.
Pharmacist
8348 WASHINGTON AVE
MOUNT PLEASANT, WI 53406
Racine County (262) 884-4030
TAMMY R MAGNUSON OT
Occupational Therapist
8348 WASHINGTON AVE
RACINE, WI 53406
Racine County (877) 576-3544
MICHAEL POTHEN MD
Family Medicine
8348 WASHINGTON AVE
MOUNT PLEASANT, WI 53406
Racine County (262) 884-4000
MS. JENNIFER L BOERGER FNP APNP
Nurse Practitioner
8348 WASHINGTON AVE
RACINE, WI 53406
Racine County (262) 884-4098
JANA BROWN PHARM D
Pharmacist
8348 WASHINGTON AVE
MOUNT PLEASANT, WI 53406
Racine County (262) 884-4030
SUSAN K ROSENBAUM PT
Physical Therapist
8348 WASHINGTON AVE
RACINE, WI 53406
Racine County (877) 576-3544
CHRISTOPHER VINCENT CATALDI M.D.
Family Medicine
8348 WASHINGTON AVE
MOUNT PLEASANT, WI 53406
Racine County (262) 884-4000

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 Mathew Pothen's NPI number?

The NPI number for Mathew Pothen is 1255505434. It was assigned to this individual provider in the NPPES registry on April 17, 2008.

Where is Mathew Pothen located?

Mathew Pothen practices at 8348 Washington Ave, Mount Pleasant, WI 53406. The listed phone number is (262) 884-4000.

What is Mathew Pothen's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Mathew Pothen enrolled in Medicare?

Yes. Mathew Pothen is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Mathew Pothen's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Mathew Pothen reassigns Medicare benefits to 2 organizations: Aurora Medical Group, Inc. (Milwaukee, WI) and Aamg Reach PLLC (Chicago, IL). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Mathew Pothen's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Mathew Pothen accept?

Health plans from Aspirus Health Plan, CareSource (Common Ground Healthcare) and UnitedHealthcare list Mathew Pothen 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.

When was this NPI record last updated?

The NPPES record for Mathew Pothen was last updated on October 23, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 months 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.