NPIMap

Individual provider Active NPI

Scott Kenneth Hetzel, MD

  • Internal Medicine Physician
  • Berlin, WI
National Provider Identifier
1417444589
Registry record updated Jul 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
73446-20 Issued in WI
Practice address
225 Memorial Dr
Berlin, WI 54923-1243
Phone
(920) 361-5770
NPI assigned
Apr 15, 2018
Last updated
Jul 22, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Internal Medicine Physician 207R00000X 73446-20 WI Primary

Addresses

Primary practice location

225 Memorial Dr
Berlin, WI 54923-1243

Mailing address

3 Neenah Ctr
Neenah, WI 54956-3070
Phone (920) 361-5770

Other practice location 1

600 Highland Ave
Madison, WI 53792-0001
Phone (608) 263-6400

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210803002242 WI Practitioner - Internal Medicine 9537416144 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Wisconsin School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Thedacare, IncorporatedGroup PAC ID 1759294887, 654 clinicians

Practice addresses (Care Compare)

225 Memorial Dr
Berlin, WI 54923-1243
Phone (920) 361-1313

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
73446-20WIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Thedacare Medical Center - Berlin, Inc. CurrentSince Jan 3, 2026 Accepting new patients
Thedacare, Incorporated CurrentSince Aug 1, 2021 Accepting new patients
Thedacare Medical Center - Berlin, Inc. CurrentSince Jan 3, 2026 Accepting new patients
Thedacare Medical Center - Shawano, Inc. Past Accepting new patients

Locations

225 Memorial Dr
Berlin, WI 54923
Phone (920) 361-1313

3 Neenah Ctr
Neenah, WI 54956
Phone (920) 454-4229

1405 Mill St
New London, WI 54961
Phone (920) 531-2000

Interoperability endpoints

  • Direct secure messaging: dcho1275928@direct.uwhealth.org
  • Direct secure messaging: shetzel312061@direct.thedacare.org

Organizations & group practices 4

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 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1523750400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626912000000",
    "number": "1417444589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 NEENAH CTR",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549563070",
            "telephone_number": "920-361-5770",
            "fax_number": "920-361-5779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 MEMORIAL DR",
            "city": "BERLIN",
            "state": "WI",
            "postal_code": "549231243",
            "telephone_number": "920-361-5770"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "600 Highland Ave",
            "address_purpose": "LOCATION",
            "city": "Madison",
            "state": "WI",
            "postal_code": "537920001",
            "country_code": "US",
            "telephone_number": "608-263-6400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HETZEL",
        "first_name": "SCOTT",
        "middle_name": "KENNETH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-15",
        "last_updated": "2021-07-22",
        "certification_date": "2021-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "73446-20",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Berlin, WI

Sources for this page

Verify at the official NPI Registry.