Katelyn Marie Backhaus, MD
Individual provider Active NPI Gastroenterology Physician · Madison, WI
NPI 1902486483 · NPPES record last updated Jun 17, 2024
Key facts
- NPI
- 1902486483
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Gastroenterology Physician 207RG0100X
- License
- 83915-20 (WI)
- Practice address
- 600 Highland Ave
Madison, WI 53792-4600 - Phone
- (608) 263-6400
- NPI assigned
- Apr 9, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240710001040 | WI | Order and Referring Only - Gastroenterology |
7416350103 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 83915-20 | WI | MD | Gastroenterology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Luke'S Methodist Hospital | Current | Accepting new patients |
Interoperability endpoints
- kbackhaus527801@direct-ehr-ssmhc.com
- kbackhaus745071@direct.unitypoint.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Gastroenterology Physician | 207RG0100X | 83915-20 | WI | Yes |
Addresses
Primary practice location
600 Highland Ave
Madison, WI 53792-4600
Mailing address
600 Highland Ave
Madison, WI 53792-0001
Other providers in Madison, WI
- Vicki Bachmann
- Kelly Lynn Bachus
- Alok Bachuwar
- Back & Neck Wellness Center Inc.
- Emily Backes
- Michelle N. Backs
- Taylor Bacon
- Christopher J Bacsik
- Piper Hartt Bacskai
- Amr Badawi
All providers in Madison, WI · Gastroenterology 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 Jun 17, 2024. 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.