Active NPI
Mary Beth Seidlitz, M.D.
- Clinical Cardiac Electrophysiology Physician
- Weston, WI
National Provider Identifier
1285668731
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Cardiac Electrophysiology Physician
- License
- 49894-020
- Practice address
- 3501 Cranberry Blvd
Weston, WI 54476-5213 - Phone
- (715) 393-1000
- NPI assigned
- Jul 10, 2006
- Last updated
- Mar 29, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 7
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | 49894-020 | WI | |
| Clinical Cardiac Electrophysiology Physician | 207RC0001X | 30021 | MN | |
| Clinical Cardiac Electrophysiology Physician | 207RC0001X | 01062283A | IN | |
| Clinical Cardiac Electrophysiology Physician | 207RC0001X | 2004036077 | MO | |
| Clinical Cardiac Electrophysiology Physician | 207RC0001X | TD061021 | ME | |
| Clinical Cardiac Electrophysiology Physician | 207RC0001X | 49894-020 | WI | Primary |
| Interventional Cardiology Physician | 207RI0011X | 49894-020 | WI |
Addresses
Primary practice location
3501 Cranberry Blvd
Weston, WI 54476-5213
Mailing address
1000 N Oak Ave
Marshfield, WI 54449-5703
Phone (715) 387-5511
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 34093200 | 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 |
|---|---|---|---|
| 01062283A | IN | MD | Clinical Cardiac Electrophysiology Physician |
| TD061021 | ME | MD | Clinical Cardiac Electrophysiology Physician |
| 2004036077 | MO | MD | Clinical Cardiac Electrophysiology Physician |
| 49894-020 | WI | MD | Clinical Cardiac Electrophysiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mercy Clinic Joplin LLC | Cardiovascular Disease | Past | Accepting new patients |
| Sjmgroup | Past | Accepting new patients | |
| Poplar Bluff Hma Physician Management, LLC | Cardiovascular Disease | Past | Accepting new patients |
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.
-
- Family Medicine Physician
- Poplar Bluff, MO
- NPI 1598710147
Cardiovascular Disease
-
- Endocrinology, Diabetes & Metabolism Physician
- Englewood, CO
- NPI 1376590034
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152489600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1301356800000",
"number": "1285668731",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1000 N OAK AVE",
"city": "MARSHFIELD",
"state": "WI",
"postal_code": "544495703",
"telephone_number": "715-387-5511"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3501 CRANBERRY BLVD",
"city": "WESTON",
"state": "WI",
"postal_code": "544765213",
"telephone_number": "715-393-1000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SEIDLITZ",
"first_name": "MARY",
"middle_name": "BETH",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-10",
"last_updated": "2011-03-29",
"status": "A"
},
"taxonomies": [
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "WI",
"license": "49894-020",
"primary": false
},
{
"code": "207RC0001X",
"taxonomy_group": "",
"desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
"state": "MN",
"license": "30021",
"primary": false
},
{
"code": "207RC0001X",
"taxonomy_group": "",
"desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
"state": "IN",
"license": "01062283A",
"primary": false
},
{
"code": "207RC0001X",
"taxonomy_group": "",
"desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
"state": "MO",
"license": "2004036077",
"primary": false
},
{
"code": "207RC0001X",
"taxonomy_group": "",
"desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
"state": "ME",
"license": "TD061021",
"primary": false
},
{
"code": "207RC0001X",
"taxonomy_group": "",
"desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
"state": "WI",
"license": "49894-020",
"primary": true
},
{
"code": "207RI0011X",
"taxonomy_group": "",
"desc": "Internal Medicine, Interventional Cardiology",
"state": "WI",
"license": "49894-020",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "34093200",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Weston, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.