NPIMap

Individual provider Active NPI

Matthew Edward Bettag, M.D.

  • Otolaryngology Physician
  • Appleton, WI
National Provider Identifier
1487646675
Registry record updated Jul 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
44145 Issued in WI
Practice address
1520 N Meade St
Appleton, WI 54911-3762
Phone
(920) 734-7181
Fax
(920) 734-0621
NPI assigned
Aug 16, 2005
Last updated
Jul 30, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 44145 WI Primary

Addresses

Primary practice location

1520 N Meade St
Appleton, WI 54911-3762

Mailing address

2424 Trefoil CT
Menasha, WI 54952-8922
Phone (920) 954-5624

Other identifiers 1

IdentifierTypeStateIssuer
34184900MedicaidWI

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
I20070601000320 WI Practitioner - Otolaryngology 4688772494 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Chicago College of Medicine and Surgery, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ear Nose and Throat Surgical Associates SCGroup PAC ID 5991803702, 6 clinicians
Ear Nose and Throat Specialists of Wisconsin SCGroup PAC ID 9830086925, 28 clinicians

Practice addresses (Care Compare)

1520 N Meade St
Appleton, WI 54911-3762
Phone (920) 734-7181

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
44145WIMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ear Nose and Throat Specialists of Wisconsin, SC Current Accepting new patients
Ear Nose and Throat Specialists of Wisconsin SC Otolaryngology Current Accepting new patients
Ear Nose & Throat Surgical Associates SC CurrentSince Jul 1, 2007 Accepting new patients

Locations

1520 N Meade St
Appleton, WI 54911
Phone (920) 560-6748

1716 Lawrence Dr
#100
De Pere, WI 54115
Phone (920) 605-3115

119 E Bell St
Neenah, WI 54956

855 N Westhaven Dr
#200
Oshkosh, WI 54904

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/FBBAAA

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 7

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": "1124150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343606400000",
    "number": "1487646675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2424 TREFOIL CT",
            "city": "MENASHA",
            "state": "WI",
            "postal_code": "549528922",
            "telephone_number": "920-954-5624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 N MEADE ST",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549113762",
            "telephone_number": "920-734-7181",
            "fax_number": "920-734-0621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BETTAG",
        "first_name": "MATTHEW",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-16",
        "last_updated": "2012-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "WI",
            "license": "44145",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34184900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

Verify at the official NPI Registry.