Ezana M Azene, MD, PHD

Primary specialty

Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X

License

60390 Issued in WI

Practice address

1836 South Ave
La Crosse, WI 54601-5429

Phone

(608) 782-7300

NPI assigned

Jun 3, 2007

Last updated

Nov 17, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in WI, IA, MN3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 3

Specialty

Diagnostic Radiology

Education

Johns Hopkins University School of Medicine, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Gundersen Lutheran Medical Center IncGroup PAC ID 2163331414, 888 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Gundersen Lutheran Medical Center Hospital, La Crosse, WI, CCN 520087
• Gundersen Boscobel Area Hospital and Clinics Hospital, Boscobel, WI, CCN 521344
• Vernon Memorial Hospital Hospital, Viroqua, WI, CCN 521348
• Veterans Memorial Hospital Hospital, Waukon, IA, CCN 161318

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Doctor of Philosophy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: eazene59664@direct.emplifyhealth.org
• FHIR API: https://fhir-myrecord.cerner.com/r4/7b17929a-d976-4002-b080-2a37b05f2444/

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Gundersen Clinic, LTD.

  • Clinic/Center
  • Lansing, IA
  • NPI 1417902933

  Corporate Director

  CMS ownership

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.

• Gundersen Lutheran Medical Center Inc

  dba Emplify Health Hamilton Clinic

  • Clinic/Center
  • La Crosse, WI
  • NPI 1225873458
  Medicare reassignment Care Compare group NPD
• Black River Health Inc

  • Critical Access Hospital
  • Black River Falls, WI
  • NPI 1811940331
  Medicare reassignment NPD
• Gundersen Clinic LTD

  • Clinic/Center
  • La Crosse, WI
  • NPI 1851343115

  IA, MN

  Medicare reassignment NPD
• Gundersen Lutheran Medical Center Inc

  dba Emplify Health La Crosse Hospital

  • General Acute Care Hospital
  • La Crosse, WI
  • NPI 1376593442

  MN

  Medicare reassignment NPD
• Memorial Hospital of Boscobel

  dba Gundersen Boscobel Area Hospital and Clinics

  • Critical Access Hospital
  • Boscobel, WI
  • NPI 1760459846
  Medicare reassignment NPD
• Moundview Memorial Hospital & Clinics, Inc

  dba Gundersen Moundview Hospital and Clinics, Inc.

  • Critical Access Hospital
  • Friendship, WI
  • NPI 1710939533
  Medicare reassignment NPD
• Prairie Du Chien Memorial Hospital Association Inc

  dba Crossing Rivers Health

  • Critical Access Hospital
  • Prairie Du Chien, WI
  • NPI 1619024197
  Medicare reassignment NPD
• St. Joseph's Health Services, Inc.

  • Clinic/Center
  • Hillsboro, WI
  • NPI 1104031798
  Medicare reassignment NPD
• Tomah Memorial Hospital Inc

  dba Tomah Health

  • Critical Access Hospital
  • Tomah, WI
  • NPI 1184765240
  Medicare reassignment NPD
• Tomah Memorial Hospital Inc

  dba Tomah Health

  • Critical Access Hospital
  • Tomah, WI
  • NPI 1992970453

  Diagnostic Radiology

  Medicare reassignment NPD
• Tri-County Memorial Hospital, Inc.

  • Rural Health Clinic/Center
  • Whitehall, WI
  • NPI 1417201864
  Medicare reassignment NPD
• Vernon Memorial Healthcare, Inc.

  dba Vernon Health

  • Critical Access Hospital
  • Viroqua, WI
  • NPI 1497750921
  Medicare reassignment NPD

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

• Gundersen Lutheran Medical Center Inc

  dba Emplify Health La Crosse Hospital

  • General Acute Care Hospital
  • La Crosse, WI
  • NPI 1376593442
  Care Compare affiliation
• Gundersen Lutheran Medical Center Inc

  dba Emplify Health Pediatric Mobile Unit

  • Clinic/Center
  • La Crosse, WI
  • NPI 1790646719

  Hospital

  Care Compare affiliation
• Gundersen Lutheran Medical Center, Inc

  dba Emplify Health Onalaska Clinic

  • Clinic/Center
  • Onalaska, WI
  • NPI 1225372923

  Hospital

  Care Compare affiliation
• Gundersen Lutheran Medical Center, Inc

  dba Emplify Health East Building

  • Clinic/Center
  • La Crosse, WI
  • NPI 1497090138

  Hospital

  Care Compare affiliation
• Gundersen Lutheran Medical Center, Inc

  dba Emplify Health Onalaska Behavioral Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Onalaska, WI
  • NPI 1871837567

  Hospital

  Care Compare affiliation
• Gundersen Lutheran Medical Center, Inc.

  dba Emplify Health

  • Air Ambulance
  • La Crosse, WI
  • NPI 1467468173

  Hospital

  Care Compare affiliation
• Memorial Hospital of Boscobel

  dba Gundersen Boscobel Area Hospital and Clinics

  • Critical Access Hospital
  • Boscobel, WI
  • NPI 1760459846
  Care Compare affiliation
• Vernon Memorial Healthcare, Inc.

  dba Vernon Health

  • Critical Access Hospital
  • Viroqua, WI
  • NPI 1497750921
  Care Compare affiliation
• Gundersen Lutheran Medical Center Inc

  dba Emplify Health Winona Campus

  • Clinic/Center
  • Winona, MN
  • NPI 1952959603

  Hospital

  Care Compare affiliation
• Veterans Memorial Hospital City of Waukon Ia

  • Critical Access Hospital
  • Waukon, IA
  • NPI 1164599643
  Care Compare affiliation

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

{
    "created_epoch": "1180828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700179200000",
    "number": "1073715975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1836 SOUTH AVE",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546015429",
            "telephone_number": "608-782-7300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1836 SOUTH AVE",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546015429",
            "telephone_number": "608-782-7300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AZENE",
        "first_name": "EZANA",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "MD, PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-03",
        "last_updated": "2023-11-17",
        "certification_date": "2023-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "WI",
            "license": "60390",
            "primary": true
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "IA",
            "license": "41211",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "MN",
            "license": "56800",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tiva Atkinson
• Elizabeth A Ault-Brinker, MD
• Cynthia S Averbeck
• Jenna K Averbeck
• Matthew Timothy Axler
• Muhammad Azhar
• Lorraine Babameto, RDN
• Vidushi Babber, M.D.
• Kai Babcock
• Casey John Bablitch, B.S., CSAC

• Vascular & Interventional Radiology Physician in La Crosse, WI
• Providers in La Crosse, WI by specialty
• Vascular & Interventional Radiology Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.