NPIMap

Individual provider Active NPI

Brian Neil Guttormsen, MD

  • Interventional Cardiology Physician
  • Appleton, WI
National Provider Identifier
1629045232
Registry record updated Mar 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
44932 Issued in WI
Practice address
5045 W Grande Market Dr
Appleton, WI 54913-8517
Phone
(920) 886-9380
Fax
(920) 886-9381
NPI assigned
Mar 2, 2006
Last updated
Mar 16, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 44932 WI
Cardiovascular Disease Physician 207RC0000X 44932 WI
Interventional Cardiology Physician 207RI0011X 44932 WI Primary

Addresses

Primary practice location

5045 W Grande Market Dr
Appleton, WI 54913-8517

Mailing address

PO Box 88040
Milwaukee, WI 53288-0040
Phone (920) 886-9380

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
I20050929000269 WI Practitioner - Interventional CardiologyPractitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 3375578271 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Interventional CardiologyAlso: Cardiovascular Disease (Cardiology), Internal Medicine
Education
Medical College of Wisconsin, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ascension Medical Group-Fox Valley Wisconsin, IncGroup PAC ID 0244142420, shared by 2 NPIs, 260 clinicians

Practice addresses (Care Compare)

1506 S Oneida St
Appleton, WI 54915-1305
Phone (920) 738-2000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting12
Varicose vein removal1-10
Leg revascularization (restoring blood flow)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
44932WIMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Heart and Vascular of Wisconsin, SC Cardiovascular Disease CurrentSince Mar 1, 2019 Accepting new patients
Ascension Calumet Hospital, Inc CurrentSince Aug 30, 2021 Accepting new patients
Ascension Medical Group-Fox Valley Wisconsin, Inc CurrentSince Aug 16, 2021 Accepting new patients
Ascension Medical Group-Fox Valley Wisconsin, Inc Cardiovascular Disease CurrentSince Aug 16, 2021 Accepting new patients

Locations

1501 S Madison St
Appleton, WI 54915
Phone (920) 730-4435

1506 S Oneida St
Appleton, WI 54915
Phone (920) 730-4950

1818 N Meade St
Appleton, WI 54911
Phone (920) 731-4101

5045 W Grande Market Dr
Appleton, WI 54913
Phone (920) 747-0505

225 Memorial Dr
Berlin, WI 54923
Phone (920) 361-1313

614 Memorial Dr
Chilton, WI 53014
Phone (800) 458-4042

600 Highland Ave
Madison, WI 53792
Phone (608) 263-0325

2301 N Lake Dr
Milwaukee, WI 53211
Phone (414) 270-4932

3801 Spring St
Mount Pleasant, WI 53405
Phone (262) 636-4011

1405 Mill St
New London, WI 54961
Phone (920) 531-2000

1420 Algoma St
New London, WI 54961
Phone (920) 828-8300

2700 W 9th Ave
Oshkosh, WI 54904
Phone (920) 223-0220

13111 N Port Washington Rd
Thiensville, WI 53097
Phone (262) 243-7300

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1141257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584316800000",
    "number": "1629045232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 88040",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532880040",
            "telephone_number": "920-886-9380",
            "fax_number": "920-886-9381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5045 W GRANDE MARKET DR",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549138517",
            "telephone_number": "920-886-9380",
            "fax_number": "920-886-9381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUTTORMSEN",
        "first_name": "BRIAN",
        "middle_name": "NEIL",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-02",
        "last_updated": "2020-03-16",
        "certification_date": "2020-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "44932",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "WI",
            "license": "44932",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "WI",
            "license": "44932",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

Verify at the official NPI Registry.