Craig S Chertack, M.D.
Individual provider Active NPI Specialist · Berlin, WI
NPI 1811979487 · NPPES record last updated Mar 28, 2018
Key facts
- NPI
- 1811979487
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 169890 (NY)
- Practice address
- 225 Memorial Dr
Berlin, WI 54923-1243 - Phone
- (920) 361-1313
- NPI assigned
- Nov 18, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
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: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180416002455 | WI | Practitioner - Orthopedic Surgery | 9931141223 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18247 | WI | MD | Orthopaedic Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Thedacare, Incorporated | Current |
Accepting new patients |
Locations
122 E College Ave
Appleton, WI 54911
Phone (920) 996-3264
225 Memorial Dr
Berlin, WI 54923
Phone (920) 361-1313
191 Memorial Dr
Ste 200
Berlin, WI 54923
Phone (920) 361-6330
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | 169890 | NY | |
| Orthopaedic Surgery Physician | 207X00000X | 18247 | WI | |
| Specialist | 174400000X | 169890 | NY | Yes |
Addresses
Primary practice location
225 Memorial Dr
Berlin, WI 54923-1243
Mailing address
331 Forestview Dr
Williamsville, NY 14221-1460
Phone (716) 689-7541
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 076011 | Other | NY | MEDICARE GROUP NUMBER |
Other providers in Berlin, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 28, 2018. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.