Scott Robert Borkenhagen, M.D.
Individual provider Active NPI Psychiatry Physician · Beaver Dam, WI
NPI 1083930879 · NPPES record last updated Mar 7, 2024
Key facts
- NPI
- 1083930879
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatry Physician 2084P0800X
- License
- 57017-20 (WI)
- Practice address
- 707 University Ave
Psychiatry
Beaver Dam, WI 53916 - Phone
- (920) 887-7181
- NPI assigned
- Apr 19, 2010
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 6
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20211222001377 | WI | Practitioner - Psychiatry | 0244666469 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 57017-20 | WI | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mercy Health System Corporation | Current | Accepting new patients | |
| MCHS Hospitals Inc | Current | Accepting new patients | |
| Beaver Dam Community Hospitals Inc | Current |
Accepting new patients | |
| Mercy Health System Corporation | Current |
Accepting new patients | |
| Mercy Health System Corporation | Current |
Accepting new patients | |
| Beaver Dam Community Hospitals Inc | Current |
Accepting new patients |
Locations
29624 Network Pl
Chicago, IL 60673
Phone (608) 741-7652
705 S University Ave
Beaver Dam, WI 53916
Phone (920) 885-6090
2600 Humes Rd
Janesville, WI 53545
Phone (608) 741-2117
2600 Humes Rd
Ste 100
Janesville, WI 53545
Phone (608) 741-2117
1000 Mineral Point Ave
Janesville, WI 53548
Phone (608) 261-6868
N2950 State Road 67
Lake Geneva, WI 53147
Phone (262) 245-0535
1000 N Oak Ave
Marshfield, WI 54449
Phone (715) 387-5111
Interoperability endpoints
- sborkenhagen102427@direct.mhemail.org
- scott.borkenhagen@marshfieldclinichealthsystem.cernerdirect.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Child & Adolescent Psychiatry Physician | 2084P0804X | 57017-20 | WI | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Psychiatry Physician | 2084P0800X | 57017-20 | WI | Yes |
Addresses
Primary practice location
707 University Ave
Psychiatry
Beaver Dam, WI 53916
Mailing address
707 University Ave
Psychiatry
Beaver Dam, WI 53916
Phone (920) 887-7181
Other practice location 1
2600 Humes Rd
Janesville, WI 53545-0490
Phone (608) 741-2117
Other providers in Beaver Dam, WI
- Sionag M Black
- Jessica Marie Blatz
- Andrea Michelle Bluel
- Asiedu Boateng
- Kristin Bonilla
- Dennis Lee Bostwick
- Kristine Braker
- Shelby Ann Brandsma
- Kailin M Brath
- Douglas Earl Bricker
All providers in Beaver Dam, WI · Psychiatry 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 7, 2024. 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.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.