Active NPI
Jeffrey W Bailet, MD
- Otolaryngology Physician
- Burlington, WI
National Provider Identifier
1225101413
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- 46488
- Practice address
- 248 McHenry St
Burlington, WI 53105-1828 - Phone
- (262) 767-8000
- NPI assigned
- Nov 16, 2006
- 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 |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | 46488 | WI | Primary |
Addresses
Primary practice location
248 McHenry St
Burlington, WI 53105-1828
Mailing address
N3293 Via Cassio
Lake Geneva, WI 53147-5113
Phone (262) 245-5747
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 34684300 | 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 |
|---|---|---|---|
| 46488 | WI | MD | Otolaryngology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lakeshore Medical Clinic, LLC | Past | Accepting new patients | |
| Aurora Medical Group, Inc. | Past | Accepting new patients | |
| Amg Illinois LTD | Past | Accepting new patients | |
| Aurora Advanced Healthcare Inc | Past | Accepting new patients |
Organizations & group practices 4
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163635200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1225101413",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "N3293 VIA CASSIO",
"city": "LAKE GENEVA",
"state": "WI",
"postal_code": "531475113",
"telephone_number": "262-245-5747"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "248 MCHENRY ST",
"city": "BURLINGTON",
"state": "WI",
"postal_code": "531051828",
"telephone_number": "262-767-8000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAILET",
"first_name": "JEFFREY",
"middle_name": "W",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "WI",
"license": "46488",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "34684300",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Burlington, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.