Active NPI
Charles D Bantle, DO
- Family Medicine Physician
- Mondovi, WI
National Provider Identifier
1689634107
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 29955
- Practice address
- 700 Buffalo St
Mondovi, WI 54755-1371 - Phone
- (715) 838-5222
- NPI assigned
- Mar 27, 2006
- Last updated
- May 28, 2019
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 29955 | WI | Primary |
Addresses
Primary practice location
700 Buffalo St
Mondovi, WI 54755-1371
Mailing address
PO Box 1510
Eau Claire, WI 54702-1510
Phone (715) 838-5552
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)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29955 | WI | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mayo Clinic Health System-Northwest Wisconsin Region, Inc. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
dba Mayo Clinic Health System-Barron
- Critical Access Hospital
- Barron, WI
- NPI 1740239557
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143417600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1559001600000",
"number": "1689634107",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1510",
"city": "EAU CLAIRE",
"state": "WI",
"postal_code": "547021510",
"telephone_number": "715-838-5552"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 BUFFALO ST",
"city": "MONDOVI",
"state": "WI",
"postal_code": "547551371",
"telephone_number": "715-838-5222"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BANTLE",
"first_name": "CHARLES",
"middle_name": "D",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-27",
"last_updated": "2019-05-28",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WI",
"license": "29955",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mondovi, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.