Edward D Bayer, MD
Individual provider Active NPI Pediatrics Physician · De Pere, WI
NPI 1891789657 · NPPES record last updated Sep 18, 2025
Key facts
- NPI
- 1891789657
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 38740 (WI)
- Practice address
- 1716 Lawrence Dr
De Pere, WI 54115-9108 - Phone
- (920) 605-3115
- Fax
- (920) 486-6826
- NPI assigned
- Sep 8, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
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 |
|---|---|---|---|---|
| I20040407000242 | WI | Practitioner - Pediatric Medicine | 0648263434 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 38740 | WI | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Gianna Molla Clinic, Inc | Current |
Accepting new patients | |
| Ear Nose & Throat Surgical Associates SC | Past |
Accepting new patients |
Locations
1716 Lawrence Dr
#100
De Pere, WI 54115
Phone (920) 605-3115
1716 Lawrence Dr
De Pere, WI 54115
Phone (888) 231-5236
Interoperability endpoints
- edward.bayer.1@25400.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 38740 | WI | Yes |
Addresses
Primary practice location
1716 Lawrence Dr
De Pere, WI 54115-9108
Mailing address
1716 Lawrence Dr
De Pere, WI 54115-9108
Phone (920) 605-3115
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 32316400 | Medicaid | WI |
Other providers in De Pere, WI
- Caitlin Quinn Barr
- Kathleen Barrow
- Amber Marie Bassindale
- Hannah Leigh Bauer
- Emily Baumler
- Bayside Chiropractic LLC
- Beautifully Broken Counseling LLC
- Christopher George Bechakas
- Bellin Memorial Hospital Inc
- Bellin Memorial Hospital Inc
All providers in De Pere, WI · Pediatrics Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 18, 2025. 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.