NPIMap

Individual provider Active NPI

Wallace B Brucker, MD

  • Orthopaedic Surgery Physician
  • Tomah, WI
National Provider Identifier
1831285881
Registry record updated Jun 21, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
48603 Issued in WI
Practice address
321 Butts Ave
Tomah, WI 54660-1412
Phone
(608) 374-0303
NPI assigned
Oct 5, 2006
Last updated
Jun 21, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 48603 WI Primary

Addresses

Primary practice location

321 Butts Ave
Tomah, WI 54660-1412

Mailing address

321 Butts Ave
Tomah, WI 54660-1412

Other identifiers 1

IdentifierTypeStateIssuer
34706400MedicaidWI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051116000179 WI Practitioner - Orthopedic Surgery 4486641982 Reassigns benefits to 8 organizations

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Richland HospitalGroup PAC ID 7618861618, 69 clinicians

Practice addresses (Care Compare)

333 E 2ND St
Richland Center, WI 53581-1914
Phone (608) 647-6321

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
48603WIMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tomah Memorial Hospital Inc CurrentSince Nov 1, 2025 Accepting new patients
Tomah Memorial Hospital Inc CurrentSince Jul 1, 2012 Accepting new patients
Black River Health Inc CurrentSince Feb 1, 2025 Accepting new patients
Black River Health Inc CurrentSince Feb 1, 2025 Accepting new patients
Reedsburg Area Medical Center Inc CurrentSince Mar 10, 2018 Accepting new patients
Mile Bluff Medical Center Inc CurrentSince Jul 1, 2012 Accepting new patients
Richland Hospital CurrentSince Mar 1, 2025 Accepting new patients
Mile Bluff Medical Center Inc Current Accepting new patients
Richland Hospital CurrentSince Mar 1, 2025 Accepting new patients
Black River Health Inc Current Accepting new patients
Mile Bluff Medical Center Inc Orthopaedic Surgery CurrentSince Jul 1, 2012 Accepting new patients
Reedsburg Area Medical Center, Inc. CurrentSince Mar 10, 2018 Accepting new patients
Tomah Memorial Hospital Inc Orthopaedic Surgery CurrentSince Jul 1, 2012 Accepting new patients
Richland Hospital Past Accepting new patients

Locations

711 W Adams St
Blk River Fls, WI 54615
Phone (715) 284-1302

402 W Lake St
Friendship, WI 53934
Phone (608) 339-3331

1040 Division St
Mauston, WI 53948
Phone (608) 847-5000

1050 Division St
Mauston, WI 53948
Phone (608) 847-6161

2000 N Dewey Ave
Reedsburg, WI 53959
Phone (608) 524-6487

333 E 2nd St
Richland Ctr, WI 53581
Phone (608) 647-6161

321 Butts Ave
Tomah, WI 54660
Phone (608) 372-2181

501 Gopher Dr
Tomah, WI 54660
Phone (608) 371-2181

28 Commerce St
Wisconsin Dells, WI 53965
Phone (608) 254-5888

Interoperability endpoints

  • Direct secure messaging: wbrucker634332@direct.emplifyhealth.org

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340236800000",
    "number": "1831285881",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "321 BUTTS AVE",
            "city": "TOMAH",
            "state": "WI",
            "postal_code": "546601412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "321 BUTTS AVE",
            "city": "TOMAH",
            "state": "WI",
            "postal_code": "546601412",
            "telephone_number": "608-374-0303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUCKER",
        "first_name": "WALLACE",
        "middle_name": "B",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-05",
        "last_updated": "2012-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "WI",
            "license": "48603",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34706400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tomah, WI

Sources for this page

Verify at the official NPI Registry.