NPIMap

Individual provider Active NPI

Steven Mark Bettag, MD

  • Medical Oncology Physician
  • Sheboygan, WI
National Provider Identifier
1669529608
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Oncology PhysicianTaxonomy code 207RX0202X
License
36813-020 Issued in WI
Practice address
1621 N Taylor Dr
Sheboygan, WI 53081-1990
Phone
(920) 458-7433
Fax
(920) 452-3594
NPI assigned
Jan 4, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Oncology Physician 207RX0202X 36813-020 WI Primary

Addresses

Primary practice location

1621 N Taylor Dr
Sheboygan, WI 53081-1990

Mailing address

1621 N Taylor Dr
Sheboygan, WI 53081-1990
Phone (920) 458-7433

Other identifiers 1

IdentifierTypeStateIssuer
32158500MedicaidWI

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
I20041112000973 WI Practitioner - Hematology/Oncology 0648234385 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hematology/Oncology
Education
Rush Medical College of Rush University, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sheboygan Physicians Group S.C.Group PAC ID 0648435214, 15 clinicians

Practice addresses (Care Compare)

1621 N Taylor Dr
Suite 100
Sheboygan, WI 53081-1993
Phone (920) 458-7433

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
0 of 100Reported as individual
Quality
0
Promoting interoperability
0
Improvement activities
0
Cost
0

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
36813-020WIMDMedical Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sheboygan Physicians Group, SC Medical Oncology CurrentSince Jul 1, 2012 Accepting new patients
Sheboygan Cancer & Blood Specialists, SC Medical Oncology PastSince Nov 3, 2004 Accepting new patients
Matthew Oncology Associates PastSince Jul 1, 2012 Accepting new patients

Locations

1621 N Taylor Dr
Sheboygan, WI 53081
Phone (920) 458-4419

1621 N Taylor Dr
Ste 100
Sheboygan, WI 53081
Phone (920) 458-7433

2920 Superior Ave
Sheboygan, WI 53081
Phone (920) 452-6000

Organizations & group practices 3

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 11

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": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1669529608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1621 N TAYLOR DR",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "530811990",
            "telephone_number": "920-458-7433",
            "fax_number": "920-452-3594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1621 N TAYLOR DR",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "530811990",
            "telephone_number": "920-458-7433",
            "fax_number": "920-452-3594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BETTAG",
        "first_name": "STEVEN",
        "middle_name": "MARK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RX0202X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Medical Oncology",
            "state": "WI",
            "license": "36813-020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32158500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sheboygan, WI

Sources for this page

Verify at the official NPI Registry.