Blaise Paul Vitale, M.D.
Individual provider Active NPI Family Medicine Physician · Grantsburg, WI
NPI 1487713723 · NPPES record last updated Dec 14, 2012
Key facts
- NPI
- 1487713723
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 32065 (WI)
- Practice address
- 257 W Saint George Ave
Grantsburg, WI 54840-7827 - Phone
- (715) 463-5317
- Fax
- (715) 463-2753
- NPI assigned
- Dec 6, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- State University of New York at Stony Brook, School of Medicine, 1988
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Burnett Medical Center Inc
Practice addresses (Care Compare)
257 W Saint George Ave
Grantburg, WI 54840-7827
Phone (715) 463-5353
Hospital & facility affiliations
- Burnett Medical Center
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 |
|---|---|---|---|---|
| I20060221000144 | WI | Practitioner - Family Practice |
2668487133 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Burnett Medical Center Inc | Family Medicine | Current |
Accepting new patients |
| Burnett Medical Center Inc | Current |
Accepting new patients | |
| Burnett Medical Center Inc | Past | Accepting new patients |
Locations
257 W Saint George Ave
Grantsburg, WI 54840
Phone (715) 463-5353
Interoperability endpoints
- bvitale642228@direct.ochin.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 32065 | WI | Yes |
Addresses
Primary practice location
257 W Saint George Ave
Grantsburg, WI 54840-7827
Mailing address
257 W Saint George Ave
Grantsburg, WI 54840-7827
Phone (715) 463-5353
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 31761500 | Medicaid | WI | |
| 660085900 | Medicaid | MN |
Other providers in Grantsburg, WI
- Susan J Sup
- Anis Ben Tahar
- Mark L Thayer
- Urology Associates, LTD.
- Abelardo Valdes
- Amy P Wachter
- Christopher John Witzany
- Kristen Yeschek
All providers in Grantsburg, WI · Family Medicine 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 Dec 14, 2012. 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.