NPIMap

Individual provider Active NPI

Stephanie L Nottestad, M.D.

  • Family Medicine Physician
  • Cambridge, WI
National Provider Identifier
1457360760
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
46323-020 Issued in WI
Practice address
704 Katie CT
Cambridge, WI 53523-9308
Phone
(608) 423-1100
Fax
(608) 423-9851
NPI assigned
Aug 5, 2006
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 46323-020 WI Primary

Addresses

Primary practice location

704 Katie CT
Cambridge, WI 53523-9308

Mailing address

704 Katie CT
Cambridge, WI 53523-9308
Phone (608) 423-1100

Other identifiers 1

IdentifierTypeStateIssuer
34677000MedicaidWI

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
I20050824000275 WI Practitioner - Family Practice 5799716338 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Wisconsin School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fort Healthcare IncGroup PAC ID 0840189718, 159 clinicians

Practice addresses (Care Compare)

704 Katie CT
Cambridge, WI 53523-9308
Phone (608) 423-1100

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
46323-020WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fort Healthcare, Inc. CurrentSince Oct 3, 2005 Accepting new patients
Fort Healthcare Inc Family Medicine Current Accepting new patients
Fort Healthcare Inc Family Medicine CurrentSince Oct 3, 2005 Accepting new patients

Locations

704 Katie Ct
Cambridge, WI 53523
Phone (608) 423-1100

611 Sherman Ave E
Fort Atkinson, WI 53538
Phone (920) 563-6667

512 Wilcox St
Fort Atkinson, WI 53538
Phone (920) 563-7366

840 W Racine St
Jefferson, WI 53549
Phone (920) 674-6000

200 E Tyranena Park Rd
Lake Mills, WI 53551
Phone (920) 648-3113

1461 W Main St
Ste B
Whitewater, WI 53190
Phone (262) 472-6839

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/8F7ruIta-JA7ecm4ommy-Q50dF1FkFe4/
  • Direct secure messaging: stephanie.nottestad@direct.forthc.com

Ownership & related parties

All facility ownership & control disclosures 7

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Fort Healthcare IncFort Atkinson, WI, CCN 520071 Hospital Corporate Director Jan 1, 2019
Fort Healthcare Internal Medicine and PediatricsFort Atkinson, WI, CCN 528600 Rural health clinic Corporate Director Jan 1, 2019
Fort Healthcare Integrated Family Care ClinicFort Atkinson, WI, CCN 528595 Rural health clinic Corporate Director Jan 1, 2019
Fort Healthcare JeffersonJefferson, WI, CCN 528596 Rural health clinic Corporate Director Jan 1, 2019
Fort Healthcare WhitewaterWhitewater, WI, CCN 528598 Rural health clinic Corporate Director Jan 1, 2019
Fort Healthcare Center for Womens HealthFort Atkinson, WI, CCN 528599 Rural health clinic Corporate Director Jan 1, 2019
Fort Healthcare Johnson Creek ClinicJohnson Creek, WI, CCN 528597 Rural health clinic Corporate Director Jan 1, 2019

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 3

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 8

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

NPI Registry JSON

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1457360760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "704 KATIE CT",
            "city": "CAMBRIDGE",
            "state": "WI",
            "postal_code": "535239308",
            "telephone_number": "608-423-1100",
            "fax_number": "608-423-9851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "704 KATIE CT",
            "city": "CAMBRIDGE",
            "state": "WI",
            "postal_code": "535239308",
            "telephone_number": "608-423-1100",
            "fax_number": "608-423-9851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOTTESTAD",
        "first_name": "STEPHANIE",
        "middle_name": "L",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-05",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "46323-020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34677000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cambridge, WI

Sources for this page

Verify at the official NPI Registry.