Anthony Jacob Brechtelsbauer, OD
Individual provider Active NPI Optometrist · Portage, WI
NPI 1760112973 · NPPES record last updated Jan 5, 2024
Key facts
- NPI
- 1760112973
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 4901005627 (MI)
- Practice address
- 2825 Hunters TRL Lowr Level
Portage, WI 53901-3429 - Phone
- (608) 742-5522
- Fax
- (608) 745-3054
- NPI assigned
- Jun 13, 2022
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 23
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Dean Health Systems Inc
Practice addresses (Care Compare)
2825 Hunters TRL
Portage, WI 53901-3429
Phone (608) 742-5522
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 22 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231215001739 | WI | Practitioner - Optometry | 2365818283 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3903 | WI | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dean Health Systems, Inc. | Current |
Accepting new patients | |
| Dean Health Systems, Inc | Current |
Accepting new patients | |
| Dean Health Systems, Inc, | Past |
Accepting new patients |
Locations
1808 W Beltline Hwy
Madison, WI 53713
Phone (608) 250-1497
515 22nd Ave
Monroe, WI 53566
Phone (608) 324-1000
2825 Hunters Trl
Portage, WI 53901
Phone (608) 742-5522
2825 Hunters Trl
Lowr
Portage, WI 53901
Phone (608) 294-6218
Interoperability endpoints
- abrechtelsbauer500697@direct-ehr-ssmhc.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 3903 | WI | |
| Optometrist | 152W00000X | 4901005627 | MI | Yes |
Addresses
Primary practice location
2825 Hunters TRL Lowr Level
Portage, WI 53901-3429
Mailing address
919 Essex Park Dr
Jackson, MI 49203-3884
Phone (517) 230-5547
Other practice location 1
2700 Wildwood Ave
Jackson, MI 49202-3933
Phone (517) 230-5547
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760112973 | Medicaid | WI |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | abrechtelsbauer500697@direct-ehr-ssmhc.com | Direct | |
| FHIR URL | https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ | Other |
Other providers in Portage, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 5, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.