Robert Vincent Castrovinci, M.D.
Individual provider Active NPI Ophthalmology Physician · Portage, WI
NPI 1265428841 · NPPES record last updated Mar 8, 2017
Key facts
- NPI
- 1265428841
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Ophthalmology Physician 207W00000X
- License
- 18851-020 (WI)
- Practice address
- 2817 New Pinery Road
Portage, WI 53901-0387 - Phone
- (608) 745-5600
- Fax
- (608) 745-5098
- NPI assigned
- Sep 20, 2005
- Reactivated
- Apr 3, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
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 |
|---|---|---|---|---|
| I20060905000033 | WI | Practitioner - Ophthalmology | 7719927110 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18851-020 | WI | MD | Ophthalmology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Divine Savior Healthcare, Inc. | Current |
Accepting new patients | |
| Divine Savior Healthcare, Inc. | Current |
Accepting new patients | |
| Dean Health Systems, Inc. | Past |
Accepting new patients | |
| Ophthalmology Ctr. , LTD. | Ophthalmology | Past |
Accepting new patients |
| Cataract and Primary Eye Care Service, LP | Ophthalmology | Past | Accepting new patients |
Locations
29980 Network Pl
Chicago, IL 60673
2817 New Pinery Rd
Portage, WI 53901
Phone (608) 745-4598
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 18851-020 | WI | Yes |
Addresses
Primary practice location
2817 New Pinery Road
Portage, WI 53901-0387
Mailing address
2817 New Pinery Road
Portage, WI 53901-0387
Phone (608) 745-5600
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2025707 | Other | WI | PHYSICIANS PLUS |
| 34890400 | Medicaid | WI |
Other providers in Portage, WI
- Rene L Buenzow
- Heidi Patricia Campion
- Brianna Capesius
- Stacy Marie Carlson
- Todd James Cason
- Jason Scott Cerkoney
- Diana L Charlebois
- Soumen Chatterjee
- Ericka Chavez
- Charisa Marie Cheek
All providers in Portage, WI · Ophthalmology Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 8, 2017. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.