Active NPI
Edgar Betancourt, M.D.
- Anatomic Pathology & Clinical Pathology Physician
- Wausau, WI
National Provider Identifier
1174593875
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- 43096
- Practice address
- 333 Pine Ridge Blvd
Wausau, WI 54401-4120 - Phone
- (715) 847-2130
- NPI assigned
- Jan 25, 2006
- Last updated
- Oct 18, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 43096 | WI | Primary |
Addresses
Primary practice location
333 Pine Ridge Blvd
Wausau, WI 54401-4120
Mailing address
2800 Westhill Dr
Wausau, WI 54401-3771
Phone (715) 847-0075
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 34061700 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 43096 | WI | MD | Anatomic Pathology & Clinical Pathology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138147200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1697587200000",
"number": "1174593875",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2800 WESTHILL DR",
"city": "WAUSAU",
"state": "WI",
"postal_code": "544013771",
"telephone_number": "715-847-0075"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "333 PINE RIDGE BLVD",
"city": "WAUSAU",
"state": "WI",
"postal_code": "544014120",
"telephone_number": "715-847-2130"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BETANCOURT",
"first_name": "EDGAR",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-25",
"last_updated": "2023-10-18",
"certification_date": "2023-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "WI",
"license": "43096",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "34061700",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wausau, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.