NPIMap

Individual provider Active NPI

Michael C Walters, MD

  • Emergency Medicine Physician
  • Portage, WI
National Provider Identifier
1063473973
Registry record updated Oct 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
43499 Issued in WI
Practice address
2817 New Pinery Rd
Portage, WI 53901-9240
Phone
(608) 745-5689
Fax
(608) 742-6098
NPI assigned
Mar 30, 2006
Last updated
Oct 12, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 43499 WI Primary

Addresses

Primary practice location

2817 New Pinery Rd
Portage, WI 53901-9240

Mailing address

2817 New Pinery Road
Divine Savior Healthcare
Portage, WI 53901-0387
Phone (608) 745-5689

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100625000120 WI Practitioner - Emergency Medicine 1456482017 Reassigns benefits to 9 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Medical College of Wisconsin, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Divine Savior Healthcare IncGroup PAC ID 5799684007, 135 clinicians

Practice addresses (Care Compare)

2817 New Pinery Rd
Portage, WI 53901-9240
Phone (608) 742-4131

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.7 of 100Reported as group
Quality
91.14
Promoting interoperability
100
Improvement activities
40
Cost
77.5

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
97.16
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
16236LAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Divine Savior Healthcare, Inc. Emergency Medicine CurrentSince Aug 19, 2012 Accepting new patients
Aspirus Riverview Hospital & Clinics, Inc. CurrentSince Aug 1, 2021 Accepting new patients
Aspirus Medford Hospital & Clinics, Inc. Current Accepting new patients
Aspirus Riverview Hospital & Clinics, Inc. Emergency Medicine Current Accepting new patients
Divine Savior Healthcare, Inc. CurrentSince Aug 19, 2012 Accepting new patients
Aspirus Medford Hospital & Clinics, Inc. CurrentSince Nov 13, 2020 Accepting new patients
Aspirus Riverview Hospital & Clinics, Inc. CurrentSince Aug 1, 2021 Accepting new patients
Aspirus Medford Hospital & Clinics, Inc. CurrentSince Nov 13, 2020 Accepting new patients
Langlade Hospital - Hotel Dieu of St. Joseph of Antigo Wisconsin Emergency Medicine Current Accepting new patients
Aspirus Medical Group, Inc. CurrentSince Nov 13, 2020 Accepting new patients
Langlade Hospital - Hotel Dieu of St Joseph of Antigo Wisconsin CurrentSince Nov 13, 2020 Accepting new patients
Keith Van Meter & Associates Past Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

110 E 5th Ave
Antigo, WI 54409
Phone (715) 623-2351

112 E 5th Ave
Antigo, WI 54409
Phone (715) 623-2331

135 S Gibson St
Medford, WI 54451
Phone (715) 748-8100

143 S Gibson St
Medford, WI 54451
Phone (715) 748-2121

2817 New Pinery Rd
Portage, WI 53901
Phone (608) 745-4598

420 Dewey St
Wisconsin Rapids, WI 54494
Phone (715) 421-7474

604 S Webb St
Wittenberg, WI 54499
Phone (715) 253-2037

Organizations & group practices 14

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 14

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350000000000",
    "number": "1063473973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2817 NEW PINERY ROAD",
            "address_2": "DIVINE SAVIOR HEALTHCARE",
            "city": "PORTAGE",
            "state": "WI",
            "postal_code": "539010387",
            "telephone_number": "608-745-5689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2817 NEW PINERY RD",
            "city": "PORTAGE",
            "state": "WI",
            "postal_code": "539019240",
            "telephone_number": "608-745-5689",
            "fax_number": "608-742-6098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTERS",
        "first_name": "MICHAEL",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-30",
        "last_updated": "2012-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WI",
            "license": "43499",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portage, WI

Sources for this page

Verify at the official NPI Registry.