Albert Jerviss Alter Jr., MD
Individual provider Active NPI Diagnostic Radiology Physician · Madison, WI
NPI 1386604346 · NPPES record last updated Jan 8, 2019
Key facts
- NPI
- 1386604346
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- License
- 19772-020 (WI)
- Practice address
- 6701 Seybold Rd
Ste 204
Madison, WI 53719-1362 - Phone
- (608) 271-7015
- Fax
- (608) 271-7015
- NPI assigned
- Mar 24, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 6
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 |
|---|---|---|---|---|
| I20040506001182 | WI | Practitioner - Diagnostic Radiology | 5698764652 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19772-020 | WI | MD | Body Imaging Physician |
| 19772 | WI | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Portage Radiology, SC | Diagnostic Radiology | Current |
Accepting new patients |
| Marshfield Clinic Inc | Current |
Accepting new patients | |
| MCHS Hospitals Inc | Current |
Accepting new patients | |
| MCHS Hospitals Inc | Current |
Accepting new patients | |
| MCHS Hospitals Inc | Current | Accepting new patients | |
| Radiology Associates of the Fox Valley, SC | Diagnostic Radiology | Past | Accepting new patients |
Locations
3501 Golf Rd
Eau Claire, WI 54701
Phone (715) 858-4200
1000 Starr Ave
Eau Claire, WI 54703
Phone (715) 858-4850
1000 N Oak Ave
Marshfield, WI 54449
Phone (715) 387-5111
135 S Gibson St
Medford, WI 54451
Phone (715) 748-8100
2817 New Pinery Rd
Portage, WI 53901
Phone (608) 745-4598
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Body Imaging Physician | 2085B0100X | 19772-020 | WI | |
| Nuclear Radiology Physician | 2085N0904X | 19772-020 | WI | |
| Diagnostic Radiology Physician | 2085R0202X | 19772 | WI | |
| Diagnostic Ultrasound Physician | 2085U0001X | 19772-020 | WI | |
| Diagnostic Radiology Physician | 2085R0202X | 19772-020 | WI | Yes |
Addresses
Primary practice location
6701 Seybold Rd
Ste 204
Madison, WI 53719-1362
Mailing address
W9107 State Route 39
Blanchardville, WI 53516-9671
Phone (608) 523-4506
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 31053200 | Medicaid | WI |
Other providers in Madison, WI
- Robert L Alt
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- Michael M Altaweel
- Alteas Health Pulmonary of Wisconsin S.C.
- Altegra Health Connections, LLC
- Jennifer Altmann
- Jessi Edith Altmann
- Altmed LLC
- Troy A Alton
- Sara Altstaetter
All providers in Madison, WI · Diagnostic Radiology 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 Jan 8, 2019. 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.