Individual provider Active NPI

Benjamin Robert Siebert, M.D.

  • Physical Medicine & Rehabilitation Physician
  • Neenah, WI
National Provider Identifier
1114154192
Registry record updated Jun 25, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
65912-20 Issued in WI
Practice address
1305 W American Dr
Neenah, WI 54956
Phone
(920) 725-9373
NPI assigned
Jun 16, 2009
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 25, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 4301096795 MI
Physical Medicine & Rehabilitation Physician 208100000X 65912-20 WI Primary

Addresses

Primary practice location

1305 W American Dr
Neenah, WI 54956

Mailing address

1305 W American Dr
Neenah, WI 54956-1993
Phone (920) 725-9373

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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 1

Enrollment IDStateProvider typePAC IDDetails
I20161130000220 WI Practitioner - Physical Medicine and Rehabilitation 4789964255 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Neuroscience Group of Northeast Wisconsin SCGroup PAC ID 6204740186, 57 clinicians

Practice addresses (Care Compare)

1305 W American Dr
Neenah, WI 54956-1993
Phone (800) 201-1194

Hospital & facility affiliations

  • Thedacare Regional Med Ctr - Neenah Hospital, Neenah, WI, CCN 520045

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301096795MIMDPhysical Medicine & Rehabilitation Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Neuroscience Group of Northeast Wisconsin SC CurrentSince Dec 27, 2016 Accepting new patients

Locations

445 W Calumet St
Appleton, WI 54915

1818 N Meade St
Appleton, WI 54911
Phone (920) 731-4101

191 Memorial Dr
Berlin, WI 54923
Phone (920) 223-5580

225 Memorial Dr
Berlin, WI 54923
Phone (920) 361-1313

130 2nd St
Neenah, WI 54956
Phone (920) 729-2063

1305 West American Dr
Neenah, WI 54956
Phone (920) 729-7687

Organizations & group practices 1

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

Hospital & facility affiliations 5

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": "1245110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529884800000",
    "number": "1114154192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1305 W AMERICAN DR",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549561993",
            "telephone_number": "920-725-9373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1305 W AMERICAN DR",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "54956",
            "telephone_number": "920-725-9373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIEBERT",
        "first_name": "BENJAMIN",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-06-16",
        "last_updated": "2018-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MI",
            "license": "4301096795",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "WI",
            "license": "65912-20",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Neenah, WI

Sources for this page

Verify at the official NPI Registry.