MARK C WICKRE (MD) – Diagnostic Radiology Physician, NPI 1063830628
Diagnostic Radiology Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,801 DIAGNOSTIC RADIOLOGY in MN
Provider Addresses for MARK C WICKRE (MD)
420 Delaware St SE
G254 Mayo Building
Minneapolis, MN 554550341
Phone: (612) 625-7634
Type: Location
200 1st St SW
Rochester, MN 559050001
Phone: (507) 284-2511
Type: Location
1836 SOUTH AVE
LA CROSSE, WI 546015429
Phone: (608) 782-7300
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2020-11-05
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 3 Medicare enrollment records; no due dates published yet.
Enrollment records
3
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20190829000058 | I | Diagnostic Radiology | MN | TBD |
| I20201022002479 | I | Diagnostic Radiology | IA | TBD |
| I20201105000580 | I | Diagnostic Radiology | WI | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 77067 | Screening mammography | 845 | 844 | $0 |
| 77063 | Screening 3d breast mammography | 707 | 706 | $0 |
| G0279 | Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066) | 122 | 119 | $0 |
| 77065 | Diagnostic mammography of 1 breast | 83 | 81 | $0 |
| 76642 | Limited ultrasound scan of 1 breast | 70 | 70 | $0 |
Insurance plans in this area (ZIP 55455)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | WI | |
| Diagnostic Radiology, Interventional Radiology, Diagnostic Radiology | WI | |
| Internal Medicine | WI | |
| - | WI | |
| Cardiovascular Disease (Cardiology), Internal Medicine, Interventional Cardiology, Cardiovascular Disease (Cardiology) | NY | |
| - | WI | |
| Physician Assistant | WI | |
| - | WI | |
| - | WI | |
| Internal Medicine | MN |
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