NPIMap

Individual provider Active NPI

Brandon Baltz, PA-C

  • Physician Assistant
  • Wausau, WI
National Provider Identifier
1366314254
Registry record updated May 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
8871 Issued in WI
Practice address
2400 Pine Ridge Blvd
Wausau, WI 54401-7803
Phone
(715) 847-2022
NPI assigned
Sep 19, 2025
Last updated
May 13, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 13, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 8871 WI Primary
Medical Physician Assistant 363AM0700X 085.011659 IL

Addresses

Primary practice location

2400 Pine Ridge Blvd
Wausau, WI 54401-7803

Mailing address

2400 Pine Ridge Blvd
Wausau, WI 54401-7803
Phone (715) 847-2022

Other practice location 1

2003 W Fulton St
Chicago, IL 60612-2345
Phone (312) 243-2223

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, WI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20251017000133 IL Practitioner - Physician Assistant 3375030844 Reassigns benefits to 6 organizations
I20260518000608 WI Practitioner - Physician Assistant 3375030844 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Midwestern University, Chicago College of Osteopathic Med, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Surgical Associates, S.C.Group PAC ID 3072400019, 26 clinicians

Practice addresses (Care Compare)

2400 Pine Ridge Blvd
Wausau, WI 54401-7803
Phone (715) 847-2022

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
085.011659ILMDMedical Physician Assistant
8871WIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Alton Urgent Care Walk in Clinic Company CurrentSince Jan 1, 2026 Accepting new patients
Belleville Urgent Care Walk-in Clinic CurrentSince Jan 1, 2026 Accepting new patients
Wood River Urgent Care and Walk in Clinic Inc Physician Assistant CurrentSince Jan 1, 2026 Accepting new patients
Waterloo Urgent Care Walk in Clinic Company CurrentSince Jan 1, 2026 Accepting new patients
MD @ Home Illinois, SC CurrentSince Sep 29, 2025 Accepting new patients
Granite City Urgent Care Walk-in Clinic CurrentSince Jan 1, 2026 Accepting new patients

Locations

1417 Washington Ave
Alton, IL 62002
Phone (618) 260-0320

2801 W Main St
Belleville, IL 62226
Phone (618) 234-3053

2003 W Fulton St
Chicago, IL 60612
Phone (312) 243-2223

2003 W Fulton St
Ste 303
Chicago, IL 60612
Phone (312) 243-2223

2861 Madison Ave
Granite City, IL 62040
Phone (618) 709-7723

907 N Illinois Route 3
Waterloo, IL 62298
Phone (618) 350-0200

211 Madison Ave
Wood River, IL 62095
Phone (618) 709-7723

14671 Telegraph Rd
Redford, MI 48239
Phone (313) 387-2100

Interoperability endpoints

  • Direct secure messaging: brandon.baltz.1@3342.direct.athenahealth.com

Organizations & group practices 7

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 17

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1758240000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778630400000",
    "number": "1366314254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 PINE RIDGE BLVD",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544017803",
            "telephone_number": "715-847-2022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 PINE RIDGE BLVD",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544017803",
            "telephone_number": "715-847-2022"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2003 W Fulton St",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606122345",
            "country_code": "US",
            "telephone_number": "312-243-2223",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BALTZ",
        "first_name": "BRANDON",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-09-19",
        "last_updated": "2026-05-13",
        "certification_date": "2026-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "8871",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085.011659",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wausau, WI

Sources for this page

Verify at the official NPI Registry.