Robert Becker, MD
Individual provider Active NPI Pediatrics Physician · Appleton, WI
NPI 1417510652 · NPPES record last updated Jun 20, 2025
Key facts
- NPI
- 1417510652
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 77484-20 (WI)
- Practice address
- 2575 E Evergreen Dr
Appleton, WI 54913-8910 - Phone
- (920) 969-5353
- Fax
- (414) 337-7201
- NPI assigned
- Apr 14, 2019
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Gastroenterology
- Education
- Medical College of Wisconsin, 2019
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
9000 W Wisconsin Ave
Ms 958
Milwaukee, WI 53226-4810
9000 W Wisconsin Ave
Ms 958
Milwaukee, WI 53226-4874
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 |
|---|---|---|---|---|
| I20260221000186 | WI | Practitioner - Gastroenterology | 6800377573 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 77484-20 | WI | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Children'S Specialty Group, Inc. | Pediatrics | Current |
Accepting new patients |
Locations
2575 E Evergreen Dr
Appleton, WI 54913
Phone (920) 969-5353
744 S Webster Ave
Green Bay, WI 54301
Phone (920) 433-6025
2550 S Ashland Ave
Green Bay, WI 54304
Phone (920) 548-7337
9000 W Wisconsin Ave
Wauwatosa, WI 53226
Phone (414) 266-2625
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Pediatrics Physician | 208000000X | 77484-20 | WI | Yes |
Addresses
Primary practice location
2575 E Evergreen Dr
Appleton, WI 54913-8910
Mailing address
2575 E Evergreen Dr
Appleton, WI 54913-8910
Phone (920) 969-5353
Other providers in Appleton, WI
- Beck Hearing Services, Inc.
- James Gerald Beck
- Kailie Beck
- Jenna Becker
- Michelle Becker
- Jennifer Bedsole
- Brittany Elizabeth Beers
- Jodi L Beggs
- Grace Begotka
- Ashley Behling
All providers in Appleton, WI · Pediatrics 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 Jun 20, 2025. 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.