Individual provider Active NPI

Haresh B Modi, MD

  • Neonatal-Perinatal Medicine Physician
  • Wausau, WI
National Provider Identifier
1780699660
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X
License
48743 Issued in WI
Practice address
2720 Plaza Dr
Suite 2200
Wausau, WI 54401-4158
Phone
(715) 847-2311
NPI assigned
Jul 29, 2006
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
Neonatal-Perinatal Medicine Physician 2080N0001X 48743 WI Primary

Addresses

Primary practice location

2720 Plaza Dr
Suite 2200
Wausau, WI 54401-4158

Mailing address

3000 Westhill Dr
Suite 303
Wausau, WI 54401-3795

Other identifiers 1

IdentifierTypeStateIssuer
34811800MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060111000418 WI Practitioner - Pediatric Medicine 3870497480 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
48743WIMDNeonatal-Perinatal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Aspirus Wausau Hospital, Inc. CurrentSince Jul 1, 2012 Accepting new patients
Aspirus Wausau Hospital, Inc. CurrentSince Jul 1, 2012 Accepting new patients
Aspirus Medford Hospital & Clinics, Inc. Current Accepting new patients
Aspirus Medford Hospital & Clinics, Inc. CurrentSince Jul 24, 2020 Accepting new patients
Aspirus Medford Hospital & Clinics, Inc. CurrentSince Jul 24, 2020 Accepting new patients
Aspirus Wausau Hospital, Inc. Current Accepting new patients
Aspirus Medical Group, Inc. Past Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

135 S Gibson St
Medford, WI 54451
Phone (715) 748-8100

2720 Plaza Dr
Ste 2200
Wausau, WI 54401
Phone (715) 847-2311

333 Pine Ridge Blvd
Wausau, WI 54401
Phone (715) 847-2160

Organizations & group practices 7

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1780699660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 WESTHILL DR",
            "address_2": "SUITE 303",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544013795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2720 PLAZA DR",
            "address_2": "SUITE 2200",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544014158",
            "telephone_number": "715-847-2311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MODI",
        "first_name": "HARESH",
        "middle_name": "B",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "WI",
            "license": "48743",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34811800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wausau, WI

Sources for this page

Verify at the official NPI Registry.