Edwin C Stanley, MD
Individual provider Active NPI Diagnostic Radiology Physician · Waussau, WI
NPI 1124148499 · NPPES record last updated Oct 21, 2019
Key facts
- NPI
- 1124148499
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- License
- 51762-20 (WI)
- Practice address
- 333 Pine Ridge Blvd
Waussau, WI 54401-2121 - Phone
- (715) 847-2283
- Fax
- (484) 503-8200
- NPI assigned
- Mar 30, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Hospital & facility affiliations 42
Medicare Care Compare profile
- Specialty
- Diagnostic Radiology
- Education
- Other, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Radiology Associates of Wausau SC
Practice addresses (Care Compare)
333 Pine Ridge Blvd
Wausau, WI 54401-4102
Phone (715) 847-2121
Hospital & facility affiliations
- Aspirus Wausau Hospital
- Aspirus Medford Hospital & Clinics, Inc
- Aspirus Rhinelander Hospital
- Aspirus Riverview Hospital & Clinics Inc
- Aspirus Ironwood Hospital
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 |
|---|---|---|---|---|
| I20130731000121 | WI | Practitioner - Diagnostic Radiology | 5799926960 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD451105 | PA | MD | Diagnostic Radiology Physician |
| 51762-20 | WI | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Radiology Associates of Wausau, SC | Diagnostic Radiology | Current |
Accepting new patients |
Locations
3200 Westhill Dr
Ste 102
Wausau, WI 54401
Phone (715) 847-2020
333 Pine Ridge Blvd
Wausau, WI 54401
Phone (715) 847-2160
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | MD451105 | PA | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Diagnostic Radiology Physician | 2085R0202X | 51762-20 | WI | Yes |
Addresses
Primary practice location
333 Pine Ridge Blvd
Waussau, WI 54401-2121
Mailing address
Bin 88399
Milawaukee, WI 53288-0399
Phone (901) 448-1463
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 21, 2019. 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.