NPIMap

Individual provider Active NPI

Tina Bettin, NP

  • Nurse Practitioner
  • Manawa, WI
National Provider Identifier
1851311955
Registry record updated Jun 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
9033 Issued in WI
Practice address
425 2ND St
Manawa, WI 54949-9279
Phone
(920) 596-3435
NPI assigned
Jul 20, 2006
Last updated
Jun 1, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 9033 WI Primary

Addresses

Primary practice location

425 2ND St
Manawa, WI 54949-9279

Mailing address

3 Neenah Ctr
Neenah, WI 54956-3070
Phone (920) 454-8208

Other practice location 1

1405 Mill St
New London, WI 54961-2155
Phone (920) 531-2400

Other identifiers 1

IdentifierTypeStateIssuer
43817400MedicaidWI

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
I20100312000973 WI Practitioner - Nurse Practitioner 0749315984 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Thedacare, IncorporatedGroup PAC ID 1759294887, 654 clinicians

Practice addresses (Care Compare)

425 2ND St
Manawa, WI 54949-9279
Phone (920) 596-3435

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Thedacare Medical Center - Shawano, Inc. CurrentSince Aug 25, 2024 Accepting new patients
Thedacare, Incorporated CurrentSince Apr 1, 2000 Accepting new patients
Thedacare Medical Center - Shawano, Inc. CurrentSince Aug 25, 2024 Accepting new patients

Locations

4480 W Spencer St
Appleton, WI 54914
Phone (920) 738-4800

3 Neenah Ctr
Neenah, WI 54956
Phone (920) 454-4229

1405 Mill St
New London, WI 54961
Phone (920) 531-2000

100 Cty Road B
Shawano, WI 54166
Phone (715) 524-2161

Interoperability endpoints

  • Direct secure messaging: tbettin26768@direct.thedacare.org

Organizations & group practices 3

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.

Hospital & facility affiliations 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622505600000",
    "number": "1851311955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 NEENAH CTR",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549563070",
            "telephone_number": "920-454-8208",
            "fax_number": "920-596-3444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 2ND ST",
            "city": "MANAWA",
            "state": "WI",
            "postal_code": "549499279",
            "telephone_number": "920-596-3435"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1405 Mill St",
            "address_purpose": "LOCATION",
            "city": "New London",
            "state": "WI",
            "postal_code": "549612155",
            "country_code": "US",
            "telephone_number": "920-531-2400",
            "fax_number": "920-531-2450",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BETTIN",
        "first_name": "TINA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-20",
        "last_updated": "2021-06-01",
        "certification_date": "2021-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "9033",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43817400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Manawa, WI

Sources for this page

Verify at the official NPI Registry.