NPIMap

Individual provider Active NPI

Paul Joseph Chestovich, M.D.

  • Surgery Physician
  • Wausau, WI
National Provider Identifier
1073762589
Registry record updated Dec 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
82519 Issued in WI
Practice address
2400 Pine Ridge Blvd
Wausau, WI 54401-7803
Phone
(715) 847-2022
NPI assigned
Sep 9, 2008
Last updated
Dec 7, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X A103131 CA
Surgery Physician 208600000X 82519 WI Primary

Addresses

Primary practice location

2400 Pine Ridge Blvd
Wausau, WI 54401-7803

Mailing address

2400 Pine Ridge Blvd
Wausau, WI 54401-7803
Phone (715) 847-2022

Other practice location 1

1707 W Charleston Blvd
#160
Las Vegas, NV 89102-2351
Phone (702) 671-5150

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, WI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230823003900 TX Practitioner - General Surgery 7214098813 Reassigns benefits to 1 organization
I20230907002338 WI Practitioner - General SurgeryPractitioner - Other (Physician) 7214098813 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Indiana University School of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Surgical Associates, S.C.Group PAC ID 3072400019, 26 clinicians

Practice addresses (Care Compare)

2400 Pine Ridge Blvd
Wausau, WI 54401-7803
Phone (715) 847-2022

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Removal of tissue20

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A103131CAMDSurgery Physician
82519WIMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
DHHS PHS Naihs Chinle Comprehensive Health Care Facility CurrentSince Apr 2, 2024 Accepting new patients
DHHS PHS Naihs Chinle Comprehensive Health Care Facility Current Accepting new patients
Surgical Associates, S.C. Surgery CurrentSince Aug 1, 2023 Accepting new patients

Locations

2400 Pine Ridge Blvd
Wausau, WI 54401
Phone (715) 847-2022

Interoperability endpoints

  • Direct secure messaging: pchestovich202164@direct.aspirus.org
  • Direct secure messaging: pchestovich13196@direct.umcsn.com

Organizations & group practices 3

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.

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": "1220918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701907200000",
    "number": "1073762589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 PINE RIDGE BLVD",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544017803",
            "telephone_number": "715-847-2022",
            "fax_number": "702-382-5388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 PINE RIDGE BLVD",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544017803",
            "telephone_number": "715-847-2022"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1707 W Charleston Blvd",
            "address_2": "#160",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891022351",
            "country_code": "US",
            "telephone_number": "702-671-5150",
            "fax_number": "702-384-6493",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHESTOVICH",
        "first_name": "PAUL",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-09-09",
        "last_updated": "2023-12-07",
        "certification_date": "2023-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "A103131",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WI",
            "license": "82519",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wausau, WI

Sources for this page

Verify at the official NPI Registry.