Beaver Dam Community Hospitals, Inc
Organization Active NPI Sports Medicine (Family Medicine) Physician · Beaver Dam, WI
NPI 1023310034 · NPPES record last updated Mar 2, 2022
Key facts
- NPI
- 1023310034
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Sports Medicine (Family Medicine) Physician 207QS0010X
- Legal business name
- BEAVER DAM COMMUNITY HOSPITALS, INC
- Practice address
- 705 S University Ave Ste 150
Beaver Dam, WI 53916 - Phone
- (920) 219-4009
- Fax
- (920) 219-9709
- NPI assigned
- Nov 23, 2010
- Organization subpart
- Yes
- Parent organization (as reported)
- MARSHFIELD CLINIC HEALTH SYSTEM INC
Authorized official
- Name
- Gordon T Edwards
- Title
- Cfo/Coo/Ao
- Phone
- (715) 387-5823
Parent organization (reported in NPPES) 1
Other NPIs on the same Medicare enrollment 14
Practitioners 7
-
John W Haeberlin, M.D.
-
Uzoma C. Okorie, MD
-
Jennifer Shepard, APNP
-
Michael E Traktman, D.O.
-
Brian James Zirgibel, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040210000666 | WI | Part B Supplier - Clinic/Group Practice | 2567370539 |
Receives reassigned benefits from 1,519 practitioners 15 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Wauwatosa, WI; Waupun, WI; Watertown, WI; Horicon, WI; Columbus, WI; Beaver Dam, WI |
National Provider Directory
- Part of
- Marshfield Clinic Health System Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Family Medicine) Physician |
207QS0010X | Yes |
Addresses
Primary practice location
705 S University Ave Ste 150
Beaver Dam, WI 53916
Mailing address
1000 N Oak Ave
Attn: Provider Enrollment Services/WWP
Marshfield, WI 54449-5703
Phone (715) 389-0660
Other names
- (Inactive) MMC - Beaver Dam - Movement & Ortho, Rehab, PT/OT/ST
Other providers in Beaver Dam, WI
- Beaver Dam Community Hospitals Inc
- Beaver Dam Community Hospitals Inc
- Beaver Dam Community Hospitals Inc
- Beaver Dam Community Hospitals Inc
- Beaver Dam Community Hospitals Inc
- Beaver Dam Dental LLC
- Beaver Dam Emergency Medicine S.C.
- Beaver Dam ENT LLC
- Beaver Dam Foot & Ankle Center, Inc.
- Beaver Dam Hearing Care, LLC
All providers in Beaver Dam, WI · Sports Medicine (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 Mar 2, 2022. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.