Brenda K Balthazor, PA
Individual provider Active NPI Medical Physician Assistant · Wausau, WI
NPI 1851316871 · NPPES record last updated Apr 8, 2020
Key facts
- NPI
- 1851316871
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- 186923 (WI)
- Practice address
- 512 S 28TH Ave
Wausau, WI 54401-4147 - Phone
- (715) 847-2021
- Fax
- (715) 847-2325
- NPI assigned
- Jul 12, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 18
Hospital & facility affiliations 12
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Aspirus Rhinelander and Tomahawk Hospitals and Clinics, Inc.
ENT and Allergy Associates SC
Practice addresses (Care Compare)
240 Maple St
Woodruff, WI 54568-9190
Phone (715) 356-8140
512 S 28TH Ave
Wausau, WI 54401-4147
Phone (715) 847-2021
824 Illinois Ave
Stevens Point, WI 54481-3112
Phone (715) 344-1600
Hospital & facility affiliations
- Aspirus Wausau Hospital
- Langlade Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 86.2 of 100
- Quality
- 84.08
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 64.31
Merit-based Incentive Payment System (MIPS)
- Final score
- 92.72 of 100
- Quality
- 99.98
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 75.74
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: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050810000355 | WI | Practitioner - Physician Assistant | 5092744078 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 186923 | WI | MD | Medical Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 186923 | WI | Yes |
Addresses
Primary practice location
512 S 28TH Ave
Wausau, WI 54401-4147
Mailing address
512 S 28TH Ave
Wausau, WI 54401-4147
Phone (715) 847-2021
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 42871300 | Medicaid | WI |
Other providers in Wausau, WI
- Balance for Growth
- Balancepoint Chiropractic LLC
- Caitlin Baldauff
- Kimberly Ann Ball
- Victoria Paige Ballard
- Brandon Baltz
- Jessica Baptist
- Gabriella Maria Baran
- Riccardo Barani
- Debra Baranowski
All providers in Wausau, WI · Medical Physician Assistant in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 8, 2020. 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.