Individual provider Active NPI

Brian N Ebo, M.D.

  • Hospitalist Physician
  • Beloit, WI
National Provider Identifier
1528564960
Registry record updated Aug 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
75805-20 Issued in WI
Practice address
Beloit Health Systems Inc
1969 W Hart Road
Beloit, WI 53511-2298
Phone
(608) 363-5971
Fax
(608) 363-5737
NPI assigned
Apr 4, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X 75805-20 WI Primary
Internal Medicine Physician 207R00000X 75805-20 WI

Addresses

Primary practice location

Beloit Health Systems Inc
1969 W Hart Road
Beloit, WI 53511-2298

Mailing address

Beloit Health Systems Inc
1969 W Hart Road
Beloit, WI 53511-2298
Phone (608) 364-2293

Other identifiers 1

IdentifierTypeStateIssuer
100177332MedicaidWI

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210921001846 WI Practitioner - Hospitalist 7618374489 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hospitalist
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Beloit Health System IncGroup PAC ID 8224947858, 138 clinicians

Practice addresses (Care Compare)

1905 E Huebbe Pkwy
Beloit, WI 53511-1842
Phone (608) 364-2200

Hospital & facility affiliations

  • Interim Healthcare of Wisconsin Home health agency, Madison, WI, CCN 527320
  • Beloit Health System Hospital, Beloit, WI, CCN 520100

Merit-based Incentive Payment System (MIPS)

Final score
80.93 of 100Reported as group
Quality
64.82
Promoting interoperability
100
Improvement activities
40
Cost
71.63

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
75805-20WIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Beloit Health System Inc Internal Medicine CurrentSince Aug 1, 2021 Accepting new patients
Beloit Health System, Inc CurrentSince Aug 1, 2021 Accepting new patients
Beloit Clinic, S.C. Internal Medicine Current Accepting new patients
Beloit Health System, Inc Past Accepting new patients

Locations

1905 E Huebbe Pkwy
Beloit, WI 53511
Phone (608) 364-2293

1969 W Hart Rd
Beloit, WI 53511
Phone (608) 364-5011

1735 Madison Rd
Beloit, WI 53511
Phone (608) 363-7510

Organizations & group practices 4

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 2

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": "1522800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724803200000",
    "number": "1528564960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "BELOIT HEALTH SYSTEMS INC",
            "address_2": "1969 W HART ROAD",
            "city": "BELOIT",
            "state": "WI",
            "postal_code": "535112298",
            "telephone_number": "608-364-2293",
            "fax_number": "608-363-5737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BELOIT HEALTH SYSTEMS INC",
            "address_2": "1969 W HART ROAD",
            "city": "BELOIT",
            "state": "WI",
            "postal_code": "535112298",
            "telephone_number": "608-363-5971",
            "fax_number": "608-363-5737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EBO",
        "first_name": "BRIAN",
        "middle_name": "N",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-04",
        "last_updated": "2024-08-28",
        "certification_date": "2021-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "WI",
            "license": "75805-20",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "75805-20",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100177332",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Beloit, WI

Sources for this page

Verify at the official NPI Registry.