Active NPI
Kenneth B. Bortin, MD
- Cardiovascular Disease Physician
- Lake Geneva, WI
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cardiovascular Disease Physician
- License
- 26253-20
- Practice address
- N2950 State Road 67
Lake Geneva, WI 53147-2655 - Phone
- (262) 245-4990
- Fax
- (262) 245-2655
- NPI assigned
- Dec 15, 2006
- Last updated
- Aug 9, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | 26253-20 | WI | Primary |
Addresses
Primary practice location
N2950 State Road 67
Lake Geneva, WI 53147-2655
Mailing address
N2950 State Road 67
Lake Geneva, WI 53147-2655
Phone (262) 245-4990
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30583300 | Medicaid | WI |
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Cardiovascular Disease (Cardiology)
- Education
- Hahnemann University College of Medicine, 1979
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Mercy Health System Corporation
Practice addresses (Care Compare)
N2950 State Rd
Suite 67
Lake Geneva, WI 53147-2655
Phone (262) 245-0535
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26253-20 | WI | MD | Cardiovascular Disease Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mercy Health System Corporation | Current | Accepting new patients | |
| Barry K Gimbel MD SC | Cardiovascular Disease | Past | Accepting new patients |
| Aurora Medical Group, Inc. | Past | Accepting new patients | |
| Columbia St. Mary's Hospital Milwaukee Inc | Past | Accepting new patients | |
| Frances Mahon Deaconess Hospital | Past | Accepting new patients |
Locations
29624 Network Pl
Chicago, IL 60673
Phone (608) 741-7652
1000 Mineral Point Ave
Janesville, WI 53548
Phone (608) 261-6868
N2950 State Road 67
Lake Geneva, WI 53147
Phone (262) 245-0535
Interoperability endpoints
- kbortin41619@direct.mhemail.org
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.
-
dba MHS Physician Services
- Multi-Specialty Clinic/Center
- Janesville, WI
- NPI 1598718603
-
dba Mercy Walworth Hospital and Medical Center
- Critical Access Hospital
- Lake Geneva, WI
- NPI 1699728550
-
dba Mercy Hospital Janesville
- General Acute Care Hospital
- Janesville, WI
- NPI 1093768962
-
- Durable Medical Equipment & Medical Supplies
- Union Grove, WI
- NPI 1245440601
-
- Cardiovascular Disease Physician
- Milwaukee, WI
- NPI 1184811440
-
dba Ascension Columbia St Mary's Hospital Ozaukee
- Psychiatric Hospital Unit
- Mequon, WI
- NPI 1417600909
-
- Critical Access Hospital
- Glasgow, MT
- NPI 1689685323
Hospital & facility affiliations 2
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Mercy Hospital Janesville
- General Acute Care Hospital
- Janesville, WI
- NPI 1093768962
-
dba Mercy Walworth Hospital and Medical Center
- Critical Access Hospital
- Lake Geneva, WI
- NPI 1699728550
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166140800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1470700800000",
"number": "1861554743",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "N2950 STATE ROAD 67",
"city": "LAKE GENEVA",
"state": "WI",
"postal_code": "531472655",
"telephone_number": "262-245-4990",
"fax_number": "262-245-2655"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "N2950 STATE ROAD 67",
"city": "LAKE GENEVA",
"state": "WI",
"postal_code": "531472655",
"telephone_number": "262-245-4990",
"fax_number": "262-245-2655"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BORTIN",
"first_name": "KENNETH",
"middle_name": "B.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-15",
"last_updated": "2016-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "WI",
"license": "26253-20",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30583300",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Lake Geneva, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.