Brant Michael Balthazor, MS, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

4424-023 Issued in WI

Practice address

2124 Kohler Memorial Dr
Sheboygan, WI 53081-3169

Phone

(883) 821-7246

NPI assigned

Jun 3, 2015

Last updated

Jan 7, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in IL, WI2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Physician Assistant

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wisconsin Spine and Pain SCGroup PAC ID 0345665469, 19 clinicians

Progressive Beginnings, LLCGroup PAC ID 7012189848, 19 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Nicholas Hospital Hospital, Sheboygan, WI, CCN 520044
• Aurora Medical Center Sheboygan County Hospital, Sheboygan, WI, CCN 520035
• Froedtert Memorial Lutheran Hospital Hospital, Milwaukee, WI, CCN 520177

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science, Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bbalthazor266559@direct.myadvocateaurora.org

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.

• Wisconsin Spine and Pain SC

  • Interventional Pain Medicine Physician
  • Sheboygan, WI
  • NPI 1790309276
  Medicare reassignment Care Compare group
• Riverside Health System

  • General Practice Physician
  • Kankakee, IL
  • NPI 1417061193
  Medicare reassignment
• Progressive Beginnings, LLC

  • Rehabilitation Clinic/Center
  • Sheboygan, WI
  • NPI 1598886152
  Care Compare group
• Wisconsin Spine and Pain SC

  • Durable Medical Equipment & Medical Supplies
  • Appleton, WI
  • NPI 1285452391
  NPD
• Riverside Health System

  dba Psychiatric Associates

  • Psychiatry Physician
  • Kankakee, IL
  • NPI 1336354430
  NPD
• Gibson Community Hospital Association

  dba Gibson Area Hospital and Health Services

  • Critical Access Hospital
  • Gibson City, IL
  • NPI 1114935681
  NPD (past)

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

• Aurora Health Care Central, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Sheboygan, WI
  • NPI 1902023955

  Hospital

  Care Compare affiliation
• Aurora Health Care Central, Inc.

  dba Aurora Medical Center Sheboygan County

  • General Acute Care Hospital
  • Sheboygan, WI
  • NPI 1922053107
  Care Compare affiliation
• Froedtert Memorial Lutheran Hospital, Inc.

  dba CDI-Froedtert Memorial Lutheran Hospital

  • General Acute Care Hospital
  • Milwaukee, WI
  • NPI 1255334173
  Care Compare affiliation
• St Nicholas Hospital-Sisters of the Third Order of St. Francis

  dba St. Nicholas Hospital Renal Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Sheboygan, WI
  • NPI 1427009992

  Hospital

  Care Compare affiliation
• St. Nicholas Hospital-Sisters of the Third Order of St Francis

  dba St Nicholas Hospital

  • General Acute Care Hospital
  • Sheboygan, WI
  • NPI 1730184342
  Care Compare affiliation

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

{
    "created_epoch": "1433289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704585600000",
    "number": "1548640774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3624 COUNTY ROAD I",
            "city": "SAUKVILLE",
            "state": "WI",
            "postal_code": "530801446",
            "telephone_number": "734-945-3484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2124 KOHLER MEMORIAL DR",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "530813169",
            "telephone_number": "883-821-7246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALTHAZOR",
        "first_name": "BRANT",
        "middle_name": "MICHAEL",
        "credential": "MS, PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-03",
        "last_updated": "2024-01-07",
        "certification_date": "2024-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085005469",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "4424-023",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bbalthazor266559@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "12203 Corporate Pkwy",
            "city": "Mequon",
            "state": "WI",
            "country_code": "US",
            "postal_code": "530923388",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "12203 Corporate Pkwy",
            "city": "Mequon",
            "state": "WI",
            "country_code": "US",
            "postal_code": "530923388",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Amanda Lynn Bacher, APNP
• Jinhee Bae-Hermann, RPH. PHD
• Shehla Baig, MD
• Brian Keith Bailey, LPN
• Michael A Baird, M.D.
• Kristin Marie Balthazor, PA-C, MPAS
• Wamiq Yahya Banday, MBBS, MD
• Sophia Bandt
• Jennifer Banholzer, NP
• Tracy Bantleon

• Physician Assistant in Sheboygan, WI
• Providers in Sheboygan, WI by specialty
• Physician Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.