Individual provider Active NPI

Brian T. Stubitsch, MD

  • Emergency Medicine Physician
  • Portage, WI
National Provider Identifier
1528041753
Registry record updated Nov 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
43813 020 Issued in WI
Practice address
2817 New Pinery Rd
Divine Savior Healthcare Inc
Portage, WI 53901-9257
Phone
(608) 742-4131
Fax
(608) 742-6098
NPI assigned
Nov 22, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 43813 020 WI Primary

Addresses

Primary practice location

2817 New Pinery Rd
Divine Savior Healthcare Inc
Portage, WI 53901-9257

Mailing address

PO Box 387
Divine Savior Healthcare Inc
Portage, WI 53901-0387
Phone (608) 742-4131

Other practice location 1

205 Parker St
Boscobel, WI 53805-1642
Phone (608) 375-4112

Other identifiers 1

IdentifierTypeStateIssuer
34146600MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address bstubitsch263546@direct-ehr-ssmhc.com Direct AGNESIAN HEALTHCARE INC
FHIR URL https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ Other AGNESIAN HEALTHCARE INC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040331001524 WI Practitioner - Emergency Medicine 0941292866 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Agnesian Healthcare IncGroup PAC ID 1658289624, 392 clinicians

Practice addresses (Care Compare)

430 E Division St
Fond Du Lac, WI 54935-4560
Phone (920) 929-2300

Hospital & facility affiliations

  • Ripon Medical Center Hospital, Ripon, WI, CCN 521321
  • Aspirus Riverview Hospital & Clinics Inc Hospital, Wisconsin Rapids, WI, CCN 520033
  • Waupun Memorial Hospital Hospital, Waupun, WI, CCN 521327

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
43813 020WIMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Aspirus Riverview Hospital & Clinics, Inc. CurrentSince May 1, 2022 Accepting new patients
Aspirus Riverview Hospital & Clinics, Inc. Emergency Medicine Current Accepting new patients
Memorial Hospital of Boscobel CurrentSince Oct 12, 2020 Accepting new patients
Memorial Hospital of Boscobel CurrentSince Oct 12, 2020 Accepting new patients
Agnesian Healthcare, Inc Current Accepting new patients
Ihc-Swedishamerican Emergency Physicians, LLC Emergency Medicine PastSince Dec 15, 2019 Accepting new patients
Emergency Medicine Associates of Madison, SC Emergency Medicine PastSince Dec 14, 2025 Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

205 Parker St
Boscobel, WI 53805
Phone (608) 375-4112

430 E Division St
Fond du Lac, WI 54935
Phone (920) 926-4200

420 E Division St
Fond du Lac, WI 54935
Phone (920) 923-7400

37868 US Highway 18
Prairie du Chien, WI 53821
Phone (608) 357-2000

507 S Main St
Viroqua, WI 54665
Phone (608) 637-2101

620 W Brown St
Waupun, WI 53963
Phone (920) 324-5581

420 Dewey St
Wisconsin Rapids, WI 54494
Phone (715) 421-7474

410 Dewey St
Wisconsin Rapids, WI 54494
Phone (715) 421-5257

Interoperability endpoints

  • Direct secure messaging: bstubitsch304907@direct.emplifyhealth.org

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 5

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": "1132617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606089600000",
    "number": "1528041753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 387",
            "address_2": "DIVINE SAVIOR HEALTHCARE INC",
            "city": "PORTAGE",
            "state": "WI",
            "postal_code": "539010387",
            "telephone_number": "608-742-4131",
            "fax_number": "608-742-6098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2817 NEW PINERY RD",
            "address_2": "DIVINE SAVIOR HEALTHCARE INC",
            "city": "PORTAGE",
            "state": "WI",
            "postal_code": "539019257",
            "telephone_number": "608-742-4131",
            "fax_number": "608-742-6098"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "205 Parker St",
            "address_purpose": "LOCATION",
            "city": "Boscobel",
            "state": "WI",
            "postal_code": "538051642",
            "country_code": "US",
            "telephone_number": "608-375-4112",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STUBITSCH",
        "first_name": "BRIAN",
        "middle_name": "T.",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-22",
        "last_updated": "2020-11-23",
        "certification_date": "2020-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WI",
            "license": "43813 020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34146600",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bstubitsch263546@direct-ehr-ssmhc.com",
            "affiliation": "Y",
            "affiliationName": "AGNESIAN HEALTHCARE INC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "bstubitsch263546@direct-ehr-ssmhc.com",
            "address_1": "430 E Division St",
            "city": "Fond Du Lac",
            "state": "WI",
            "country_code": "US",
            "postal_code": "549354560",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "AGNESIAN HEALTHCARE INC",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "430 E Division St",
            "city": "Fond Du Lac",
            "state": "WI",
            "country_code": "US",
            "postal_code": "549354560",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Portage, WI

Sources for this page

Verify at the official NPI Registry.