NPIMap

Individual provider Active NPI

Andrew Beine, MD

  • Family Medicine Physician
  • Chilton, WI
National Provider Identifier
1194256040
Registry record updated Aug 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
69897-20 Issued in WI
Practice address
618 Memorial Dr
Chilton, WI 53014-1568
Phone
(920) 849-3800
NPI assigned
Mar 22, 2017
Last updated
Aug 6, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 69897-20 WI Primary

Addresses

Primary practice location

618 Memorial Dr
Chilton, WI 53014-1568

Mailing address

618 Memorial Dr
Chilton, WI 53014-1568
Phone (920) 849-3800

Other identifiers 1

IdentifierTypeStateIssuer
7444242674MedicaidWI

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
I20200818002251 WI Practitioner - Family Practice 3870837438 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

618 Memorial Dr
Chilton, WI 53014-1568
Phone (920) 849-3800

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Ascension Medical Group-Fox Valley Wisconsin, Inc CurrentSince Aug 6, 2020 Accepting new patients
Ascension Medical Group-Fox Valley Wisconsin, Inc CurrentSince Aug 6, 2020 Accepting new patients
Ascension Calumet Hospital, Inc CurrentSince Aug 24, 2020 Accepting new patients

Locations

1501 S Madison St
Appleton, WI 54915
Phone (920) 730-4435

614 Memorial Dr
Chilton, WI 53014
Phone (800) 458-4042

618 Memorial Dr
Chilton, WI 53014
Phone (920) 849-3800

2700 W 9th Ave
Oshkosh, WI 54904
Phone (920) 223-0220

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Willowdale Health ServicesNew Holstein, WI, CCN 525411 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Feb 1, 2023
Feb 1, 2023
Homestead Health ServicesNew Holstein, WI, CCN 525546 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Feb 1, 2023
Feb 1, 2023

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 3

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

Hospital & facility affiliations 8

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": "1490140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628208000000",
    "number": "1194256040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "618 MEMORIAL DR",
            "city": "CHILTON",
            "state": "WI",
            "postal_code": "530141568",
            "telephone_number": "920-849-3800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "618 MEMORIAL DR",
            "city": "CHILTON",
            "state": "WI",
            "postal_code": "530141568",
            "telephone_number": "920-849-3800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEINE",
        "first_name": "ANDREW",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-22",
        "last_updated": "2021-08-06",
        "certification_date": "2021-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "69897-20",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7444242674",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chilton, WI

Sources for this page

Verify at the official NPI Registry.