Active NPI
Davietta Butty
- Pediatrics Physician
- New Berlin, WI
National Provider Identifier
1669861548
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 66509-20
- Practice address
- 4855 S Moorland Rd
New Berlin, WI 53151 - Phone
- (262) 432-7599
- Fax
- (262) 432-7694
- NPI assigned
- Jan 15, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 66509-20 | WI | Primary |
Addresses
Primary practice location
4855 S Moorland Rd
New Berlin, WI 53151
Mailing address
1630 W 33Rd PL
Chicago, IL 60608-6202
Phone (248) 761-6924
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669861548 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 66509-20 | WI | MD | Pediatrics Physician |
Interoperability endpoints
- dbutty38861@direct.chw.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1421280000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1530748800000",
"number": "1669861548",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1630 W 33RD PL",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606086202",
"telephone_number": "248-761-6924"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4855 S MOORLAND RD",
"city": "NEW BERLIN",
"state": "WI",
"postal_code": "53151",
"telephone_number": "262-432-7599",
"fax_number": "262-432-7694"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUTTY",
"first_name": "DAVIETTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-01-15",
"last_updated": "2018-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "WI",
"license": "66509-20",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1669861548",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in New Berlin, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.