Elizabeth S Bensen, M.D.
Individual provider Active NPI Physical Medicine & Rehabilitation Physician · Fond Du Lac, WI
NPI 1366433435 · NPPES record last updated Apr 29, 2024
Key facts
- NPI
- 1366433435
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Medicine & Rehabilitation Physician 208100000X
- License
- 38153 (WI)
- Practice address
- 421 Camelot Dr
Fond Du Lac, WI 54935-8335 - Phone
- (920) 926-8571
- NPI assigned
- Oct 28, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 23
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Physical Medicine and Rehabilitation
- Education
- Other, 1992
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Lifepoint Rehab Physician Services LLC
Agnesian Healthcare Inc
Practice addresses (Care Compare)
3572 Hesper Rd
Billings, MT 59102-6891
Phone (406) 413-6200
420 E Division St
Fond Du Lac, WI 54935-4560
Phone (920) 923-7400
430 E Division St
Fond Du Lac, WI 54935-4560
Phone (920) 929-2300
608 W Brown St
Waupun, WI 53963-1702
Phone (920) 324-6800
620 W Brown St
Waupun, WI 53963-1702
Phone (920) 324-6531
777 Hospital Way
Pocatello, ID 83201-5175
Phone (208) 239-1000
Hospital & facility affiliations
- SSM Health St Agnes Hospital-Fond Du Lac
- Portneuf Medical Center
- Portneuf Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in WI, MT, ID
- 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 |
|---|---|---|---|---|
| I20050929001053 | WI | Practitioner - Physical Medicine and Rehabilitation | 5597790378 | Reassigns benefits to 2 organizations |
| I20240805002035 | MT | Practitioner - Physical Medicine and Rehabilitation | 5597790378 | Reassigns benefits to 2 organizations |
| I20250506000718 | ID | Practitioner - Physical Medicine and Rehabilitation | 5597790378 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 38153 | WI | MD | Physical Medicine & Rehabilitation Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dean Health Systems, Inc. | Current |
Accepting new patients | |
| Dean Health Systems, Inc | Current |
Accepting new patients | |
| RCHP Billings - Missoula LLC | Current |
Accepting new patients | |
| Lifepoint Rehab Physician Services LLC | Physical Medicine & Rehabilitation | Current |
Accepting new patients |
| Lifepoint Rehab Physician Services LLC | Physical Medicine & Rehabilitation | Current |
Accepting new patients |
| Agnesian Healthcare, Inc | Current | Accepting new patients | |
| Agnesian Healthcare Inc | Current |
Accepting new patients | |
| RCHP Billings - Missoula LLC | Current |
Accepting new patients |
Locations
777 Hospital Way
Pocatello, ID 83201
Phone (208) 239-1000
1200 Hospital Way
Pocatello, ID 83201
Phone (208) 232-2570
777 Hospital Way
Fl 5
Pocatello, ID 83201
Phone (208) 239-1000
3572 Hesper Rd
Billings, MT 59102
Phone (406) 413-6200
2831 Fort Missoula Rd
Ste 303
Missoula, MT 59804
Phone (406) 327-4412
2827 Fort Missoula Rd
Missoula, MT 59804
Phone (406) 327-4202
2230 N Reserve St
Missoula, MT 59808
Phone (406) 721-0533
2230 N Reserve St
Ste 402
Missoula, MT 59808
Phone (406) 327-3850
330 Seven Springs Way
Brentwood, TN 37027
Phone (615) 920-7780
420 E Division St
Fond du Lac, WI 54935
Phone (920) 923-7400
421 Camelot Dr
Fond du Lac, WI 54935
Phone (920) 923-7940
700 S Park St
Madison, WI 53715
Phone (608) 260-2900
515 22nd Ave
Monroe, WI 53566
Phone (608) 324-1000
608 W Brown St
Waupun, WI 53963
Phone (920) 324-6800
Interoperability endpoints
- ebensen330675@direct-ehr-ssmhc.com
- ebensen1265099@ahs.direct-ci.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician | 208100000X | 38153 | WI | Yes |
Addresses
Primary practice location
421 Camelot Dr
Fond Du Lac, WI 54935-8335
Mailing address
420 E Division St
Fond Du Lac, WI 54935-4560
Phone (920) 926-8340
Other practice location 1
700 S Park St
Madison, WI 53715-1830
Phone (608) 251-6100
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 260027755 | Other | WI | RAILROAD MEDICARE |
| 32247200 | Medicaid | WI |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | ebensen330675@direct-ehr-ssmhc.com | Direct | |
| FHIR URL | https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ | Other | |
| Direct Messaging Address | ebensen330675@direct-ehr-ssmhc.com | Direct | |
| FHIR URL | https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ | Other |
Other providers in Fond Du Lac, WI
- Sara Ann Beltz
- Rachel Rae Bending
- Erin Clark Benedict
- Charles P Bennett
- Scott Blanton Bennion
- Josh Bruce Berceau
- Elizabeth J Berenz
- Melissa Dawn Berggren
- David C. Beringer
- Morgan Leigh Bernard
All providers in Fond Du Lac, WI · Physical Medicine & Rehabilitation 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 Apr 29, 2024. 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.