Active NPI
Douglas Edward Bertram, L.AC
- Acupuncturist
- Madison, WI
National Provider Identifier
1720196561
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- 482-055
- Practice address
- 1628 Winnebago St Apt 1
Madison, WI 53704-5559 - Phone
- (608) 692-7785
- NPI assigned
- Aug 29, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Acupuncturist | 171100000X | 482-055 | WI | Primary |
Addresses
Primary practice location
1628 Winnebago St Apt 1
Madison, WI 53704-5559
Mailing address
1628 Winnebago St Apt 1
Madison, WI 53704-5559
Phone (608) 692-7785
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 |
|---|---|---|---|
| 482-055 | WI | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1720196561",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1628 WINNEBAGO ST APT 1",
"city": "MADISON",
"state": "WI",
"postal_code": "537045559",
"telephone_number": "608-692-7785"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1628 WINNEBAGO ST APT 1",
"city": "MADISON",
"state": "WI",
"postal_code": "537045559",
"telephone_number": "608-692-7785"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERTRAM",
"first_name": "DOUGLAS",
"middle_name": "EDWARD",
"credential": "L.AC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "WI",
"license": "482-055",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Madison, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.