Michael J Ebersold, MD
Individual provider Active NPI Neurological Surgery Physician · La Crosse, WI
NPI 1093770752 · NPPES record last updated Jun 20, 2014
Key facts
- NPI
- 1093770752
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Neurological Surgery Physician 207T00000X
- License
- 17555 (WI)
- Practice address
- 1836 South Ave
La Crosse, WI 54601-5429 - Phone
- (608) 782-7300
- NPI assigned
- Apr 18, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Owned or controlled facilities with NPI records 5
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
All facility ownership & control disclosures 6
| Facility | Type | Role | Since |
|---|---|---|---|
| Gundersen St Elizabeth'S Hospital and Clinics |
Hospital | Corporate Director | Jul 1, 2016 |
| Gundersen St Elizabeth'S Hospital and Clinics |
Hospital | Corporate Director | Jul 1, 2016 |
| Gundersen St Elizabeth'S Care Center |
Skilled nursing facility | Corporate Director | Jul 1, 2016 |
| Gundersen St Elizabeth'S Home Care |
Home health agency | Corporate Director | Jul 1, 2016 |
| Gundersen St Elizabeth'S Hospital and Clinics - Wabasha |
Rural health clinic | Corporate Director | Jul 1, 2016 |
| Gundersen St Elizabeth'S Hospital and Clinics - Alma |
Rural health clinic | Corporate Director | Jul 1, 2016 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20031201000307 | WI | Practitioner - Neurosurgery | 6800791112 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20385 | MN | MD | Neurological Surgery Physician |
| 17555 | WI | MD | Neurological Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gundersen Lutheran Medical Center, Inc | Current |
Accepting new patients | |
| Gundersen Lutheran Express Care, Inc | Current |
Accepting new patients | |
| Gundersen Lutheran Medical Center Inc | Current |
Accepting new patients | |
| Gundersen Lutheran Medical Center Inc | Current | Accepting new patients | |
| Gundersen Clinic LTD | Current |
Accepting new patients |
Locations
1836 South Ave
La Crosse, WI 54601
Phone (608) 788-8102
1910 South Ave
La Crosse, WI 54601
Phone (608) 775-2287
1600 Main St
Onalaska, WI 54650
Phone (608) 783-4681
310 W Main St
Sparta, WI 54656
Phone (608) 269-1700
Interoperability endpoints
- mebersold21766@direct.emplifyhealth.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurological Surgery Physician | 207T00000X | 17555 | WI | Yes |
| Neurological Surgery Physician | 207T00000X | 20385 | MN |
Addresses
Primary practice location
1836 South Ave
La Crosse, WI 54601-5429
Mailing address
1836 South Ave
La Crosse, WI 54601-5429
Phone (608) 782-7300
Other providers in La Crosse, WI
- Jade Eaton
- Todd L Ebbert
- Laura Jean Eber
- Christopher M Eberlein
- Jenni Lee Ebersberger
- Caressa Alin Marie Eckley
- Daniel J Ecklund
- Katherine Eckstein
- Lee H. Eckstein
- Michaela Kay Eckstein
All providers in La Crosse, WI · Neurological Surgery 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 Jun 20, 2014. 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.