NPIMap

Individual provider Active NPI

Mollie J Berg, PA-C

  • Medical Physician Assistant
  • Wausau, WI
National Provider Identifier
1124352604
Registry record updated Dec 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
2496023 Issued in WI
Practice address
512 S 28TH Ave
Wausau, WI 54401-4147
Phone
(715) 847-2021
Fax
(715) 847-2325
NPI assigned
Sep 30, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 2496023 WI Primary

Addresses

Primary practice location

512 S 28TH Ave
Wausau, WI 54401-4147

Mailing address

512 S 28TH Ave
Wausau, WI 54401-4147
Phone (715) 847-2021

Other names 1

  • Mollie J Baeseman Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091029000123 WI Practitioner - Physician Assistant 5193862878 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
ENT and Allergy Associates SCGroup PAC ID 2062429608, 25 clinicians

Practice addresses (Care Compare)

512 S 28TH Ave
Wausau, WI 54401-4147
Phone (715) 847-2021

Hospital & facility affiliations

  • Aspirus Wausau Hospital Hospital, Wausau, WI, CCN 520030
  • Aspirus Rhinelander Hospital Hospital, Rhinelander, WI, CCN 520019

Merit-based Incentive Payment System (MIPS)

Final score
92.72 of 100Reported as group
Quality
99.98
Promoting interoperability
100
Improvement activities
40
Cost
75.74

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2496023WIMDMedical Physician Assistant

Interoperability endpoints

  • Direct secure messaging: mberg20650@direct.aspirus.org

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 26

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 26

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1254268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671667200000",
    "number": "1124352604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "512 S 28TH AVE",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544014147",
            "telephone_number": "715-847-2021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "512 S 28TH AVE",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544014147",
            "telephone_number": "715-847-2021",
            "fax_number": "715-847-2325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERG",
        "first_name": "MOLLIE",
        "middle_name": "J",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-30",
        "last_updated": "2022-12-22",
        "certification_date": "2022-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WI",
            "license": "2496023",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MOLLIE",
            "last_name": "BAESEMAN",
            "middle_name": "J",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Wausau, WI

Sources for this page

Verify at the official NPI Registry.