MICHAEL E BROUETTE PA-C
NPI 1437132669
Physician Assistant in Portage, WI
NPI Status: Active since November 22, 2005
Contact Information
2825 HUNTERS TRL
PORTAGE, WI
ZIP 53901
Phone: (608) 742-7161
Fax: (608) 745-3990
- Individual
- Male
- Years of Experience 21
- Physician Assistant
- Accepts Insurance
- Accepts Medicare Approved Payment
- PECOS Enrolled
About MICHAEL BROUETTE
This page provides the complete NPI Profile along with additional information for Michael Brouette, a primary care provider established in Portage, Wisconsin with a medical specialization in Physician Assistant and more than 21 years of experience. He graduated from University Of Wisconsin School Of Medicine in 2005. The healthcare provider is registered in the NPI registry with number 1437132669 assigned on November 2005. The practitioner's primary taxonomy code is 363A00000X with license number 1860023 (WI). The provider is registered as an individual and his NPI record was last updated 5 years ago.
- NPI
- 1437132669
- Provider Name
- MICHAEL E BROUETTE PA-C
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 2825 HUNTERS TRL PORTAGE, WI 53901
- Location Phone
- (608) 742-7161
- Location Fax
- (608) 745-3990
- Mailing Address
- 2825 HUNTERS TRL PORTAGE, WI 53901
- Mailing Phone
- (608) 742-7161
- Mailing Fax
- (608) 745-3990
- Medical School Name
- UNIVERSITY OF WISCONSIN SCHOOL OF MEDICINE
- Graduation Year
- 2005
- Is Sole Proprietor?
- No
- Enumeration Date
- 11-22-2005
- Last Update Date
- 11-04-2020
- Code Navigator
A primary care provider (PCP) like Michael Brouette sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Physician Assistant
- Taxonomy Code
- 363A00000X
- Type
- Physician Assistants & Advanced Practice Nursing Providers
- License No.
- 1860023
- License State
- WI
- Taxonomy Description
- A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Anthem Bronze Preferred/Broad 5000 (3 Free PCP Visits + $0 Select Drugs + Incentives) - POS
- Anthem Bronze Preferred/Broad HSA (+ Incentives) - POS
- Anthem Bronze Preferred/Broad Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
- Anthem Gold Preferred/Broad 1000 ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
- Anthem Gold Preferred/Broad Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
- Anthem Heart Healthy Bronze Preferred/Broad 0 Med Ded ($0 Virtual PCP+$0 Select Drugs+Incentives) - POS
- Anthem Silver Preferred/Broad 4000 (3 Free PCP Visits + $0 Select Drugs + Incentives) - POS
- Anthem Silver Preferred/Broad 5300 (3 Free PCP Visits + $0 Select Drugs + Incentives) - POS
- Anthem Silver Preferred/Broad Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
- Dean Bronze $0 Copay PCP Visits - HMO
- Dean Bronze Share - HMO
- Dean Catastrophic - HMO
- Dean Expanded Bronze Standard - HMO
- Dean Gold HSA - HMO
- Dean Gold Share - HMO
- Dean Gold Standard - HMO
- Dean Silver $0 Copay PCP Visits - HMO
- Dean Silver Share - HMO
- Dean Silver Standard - HMO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
Identifier | Type / Code | Identifier State | Identifier Issuer |
---|---|---|---|
1437132669 | MEDICAID (05) | WI |
Medicare Participation & PECOS Enrollment Status
Michael Brouette is registered with Medicare and accepts claims assignment, this means the provider accepts the approved amount for the cost of rendered services as full payment. Participating providers may not charge beneficiaries more than the approved amount for their services. Please keep in mind that beneficiaries still have to pay a coinsurance or copayment amount for a visit or service.
Michael Brouette is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
Is the provider registered in PECOS? Yes
PECOS PAC ID: 4981632122
What is the PECOS Associate Control ID?
A PAC ID is a unique 10-digit number assigned to an individual or organization healthcare provider in PECOS. The PAC ID is used to link together all the provider information, like tax identification numbers and organizational names. A PAC ID can be connected to multiple Enrollment IDs if an individual or organization has enrolled in PECOS more than once.PECOS Enrollment ID: I20050729000518
What is the Provider Enrollment ID?
The Enrollment ID is a unique alphanumeric 15-digit code assigned to each new provider's PECOS enrollment application. The Enrollment ID is used to link together all the provider enrollment information like enrollment type, state, provider specialty, and reassignment of benefits.Accepts Medicare Assignment? Yes
What does it mean "accepts medicare assignment"?
When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts.
A provider who doesn't accept assignment may charge you up to 15% over the Medicare-approved amount. This is known as the limiting charge. You may have to pay this amount, or it may be covered by another insurer.Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): Yes
Eligible to Order or Refer Power Mobility Devices: Yes
Provider Referred Orders for Durable Medical Equipment, Devices & Supplies
The following list reflects the services, supplies or durable medical equipment ordered by this provider to a DME supplier on behalf of patients. The information below is derived from Medicare claims data and reflects the BETOS category, HCPCS code information and the number times each service was submitted under the Medicare fee-for-service program.
Durable Medical Equipment
DME-Other DME (DE017N)
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips (HCPCS:A4253)
8 DME suppliers used 30 Medicare Claims 87 Services Paid
DME-Other DME (DE001N)
Full face mask used with positive airway pressure device, each (HCPCS:A7030)
4 DME suppliers used 12 Medicare Claims 12 Services Paid
DME-Other DME (DE001N)
Face mask interface, replacement for full face mask, each (HCPCS:A7031)
4 DME suppliers used 11 Medicare Claims 27 Services Paid
DME-Other DME (DE001N)
Tubing used with positive airway pressure device (HCPCS:A7037)
3 DME suppliers used 12 Medicare Claims 12 Services Paid
DME-Other DME (DE001N)
Filter, disposable, used with positive airway pressure device (HCPCS:A7038)
6 DME suppliers used 16 Medicare Claims 96 Services Paid
DME-Other DME (DE000N)
Nebulizer, with compressor (HCPCS:E0570)
2 DME suppliers used 11 Medicare Claims 11 Services Paid
DME-Other DME (DE001N)
Continuous positive airway pressure (cpap) device (HCPCS:E0601)
2 DME suppliers used 11 Medicare Claims 11 Services Paid
DME-Oxygen and Supplies (DC002N)
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate (HCPCS:E1390)
3 DME suppliers used 43 Medicare Claims 43 Services Paid
DME-Oxygen and Supplies (DC002N)
Portable oxygen concentrator, rental (HCPCS:E1392)
3 DME suppliers used 39 Medicare Claims 39 Services Paid
DME-Other DME (DE017N)
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service (HCPCS:K0553)
4 DME suppliers used 31 Medicare Claims 31 Services Paid
DME-Other DME (DE000N)
Pharmacy dispensing fee for inhalation drug(s); per 30 days (HCPCS:Q0513)
4 DME suppliers used 15 Medicare Claims 15 Services Paid
Unknown
Treatment-Treatment - Miscellaneous (RX029N)
Prednisone, immediate release or delayed release, oral, 1 mg (HCPCS:J7512)
1 DME suppliers used 12 Medicare Claims 1800 Services Paid
Drugs Administered Through DME
DME-Drugs Administered Through DME (DG006N)
Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme (HCPCS:J7620)
4 DME suppliers used 16 Medicare Claims 2280 Services Paid
Areas of Expertise
The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.
Administration of influenza virus vaccine
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit
Complete blood cell count (red cells, white blood cell, platelets), automated test
Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count
Established patient office or other outpatient visit, 20-29 minutes
Established patient office or other outpatient visit, 30-39 minutes
Fee covid-19 vac 13 res
Influenza vaccine, quadrivalent inactivated, 0.5 ml dosage
Insertion of needle into vein for collection of blood sample
Manual urinalysis test with examination using microscope, automated
Red blood count, automated test
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report
Testing for presence of drug, read by instrument assisted observation
Transitional care management services for problem of high complexity
The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.
This service was performed 49 times for 49 patientsAn annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.
This service was performed 106 times for 106 patientsA complete blood cell count (CBC) is an automated test that measures different components of the blood, including red cells, white cells, and platelets. It helps assess overall health, detect disorders like anemia or infection, and monitor medical treatments.
This service was performed 191 times for 139 patientsA Complete Blood Cell Count is a common test that measures various components of the blood, including red cells (carry oxygen), white cells (fight infection), and platelets (help blood clot). An automated test ensures accuracy. The differential count provides detailed information about white cell types.
This service was performed 30 times for 26 patientsThis is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
This service was performed 179 times for 94 patientsThis is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
This service was performed 496 times for 259 patientsThe "Fee Covid-19 Vac 13 Res" service refers to a charge for the 13th dose of the Covid-19 vaccine, typically for individuals requiring additional doses due to specific health conditions. It's crucial to follow your healthcare provider's advice for your health safety.
This service was performed 24 times for 24 patientsThe quadrivalent inactivated influenza vaccine is a shot given to protect against four strains of the flu virus. This 0.5 ml dosage helps your body develop immunity to the virus. It's an important step in preventing flu-related complications.
This service was performed 45 times for 45 patientsThis procedure involves inserting a small needle into a vein, typically in your arm, to collect a blood sample. It's a quick and simple process to help diagnose or monitor health conditions. You may feel a small prick, but discomfort is minimal.
This service was performed 495 times for 213 patientsA manual urinalysis test with automated microscopic examination is a lab process that checks your urine for health indicators. It involves a machine scanning your sample to identify any abnormal elements, which can assist in diagnosing various conditions.
This service was performed 68 times for 51 patientsAn automated red blood count test is a routine lab procedure to measure the number of red blood cells in your blood. These cells carry oxygen throughout the body. The test helps assess overall health and detect conditions like anemia or polycythemia.
This service was performed 21 times for 19 patientsAn electrocardiogram (ECG) is a non-invasive test that records your heart's electrical activity. Using 12 leads attached to your body, it captures data to help identify heart conditions. A doctor interprets the results and provides a report.
This service was performed 44 times for 44 patientsThis procedure involves testing a sample, typically urine, to determine if specific drugs are present. An instrument helps read the results accurately. It's a common method to monitor substance use or check medication compliance. It's simple, quick, and usually painless.
This service was performed 12 times for 12 patientsTransitional care management services are designed to ensure a smooth transition from a hospital to home or another care setting for patients with complex health issues. These services include medication management, patient education, and coordination with healthcare providers.
This service was performed 16 times for 16 patientsPhysician Visit Costs
The typical physician office visit costs for Medicare beneficiaries in this area are: $20.73 for a new patient copayment and $16.84 for an established patient copayment.
The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.
For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.
The prices below reflect the costs for new and established patients in the 53901 ZIP code area.
New Patients Visit Costs *
The most utilized procedure code for new patients office visits is 99203
- Average New Patient Price $82.92
- Minimum New Patient Price $53.9
- Maximum New Patient Price $163.24
- Average New Patient Copayment $20.73
- Minimum New Patient Copayment $13.47
- Maximum New Patient Copayment $40.81
Established Patients Visit Costs *
The most utilized procedure code for established patients office visits is 99213
- Average Established Patient Price $67.37
- Minimum Established Patient Price $17.4
- Maximum Established Patient Price $133.76
- Average Established Patient Copayment $16.84
- Minimum Established Patient Copayment $4.35
- Maximum Established Patient Copayment $33.44
* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.
Find Provider Hospital Affiliations - Privileges
Doctors and physicians must apply for hospital privileges to treat patients at hospitals. Find out if your doctor has privileges to practice at your preferred hospital by using the hospital affiliation information below based on recent medical claims.
Hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the medical claims NPI number and place of service code. Additionally, to further determine provider hospital affiliation the clinician must have provided services to at least three patients on three different dates in the last 12 months. Michael Brouette is affiliated with the following medical facilities:
Hospital Name | Address | Phone | Hospital Type | Overall Rating |
---|---|---|---|---|
DIVINE SAVIOR HEALTHCARE | 2817 NEW PINERY ROAD PORTAGE, WI 53901 | (608) 742-4131 | Acute Care Hospitals | |
SSM HEALTH ST CLARE HOSPITAL - BARABOO | 707 14TH ST BARABOO, WI 53913 | (608) 356-1400 | Acute Care Hospitals | |
SSM HEALTH ST MARY'S HOSPITAL - MADISON | 700 SOUTH PARK ST MADISON, WI 53715 | (608) 251-6100 | Acute Care Hospitals |
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
1 | 4 | 3 | 7 | 1 | 3 | 2 | 6 | 6 | 9 |
Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
2 | 4 | 6 | 7 | 2 | 3 | 4 | 6 | 12 | |
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
2 + 4 + 6 + 7 + 2 + 3 + 4 + 6 + 1 + 2 + 24 = 61 | |||||||||
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
70 - 61 = 9 | 9 |
The NPI number 1437132669 is valid because the calculated check digit 9 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 20 providers are registered at the same or nearby location.
NPI | Name / Type | Taxonomy | Address |
---|---|---|---|
1649238932 | PAUL J SLAVIK MD Individual | Internal Medicine | 2825 HUNTERS TRL 1ST FLOOR PORTAGE, WI 53901 (608) 742-7161 |
1235187105 | DARRELL R PARKER PA-C Individual | Physician Assistant | 2825 HUNTERS TRL 1ST FLOOR PORTAGE, WI 53901 (608) 742-7161 |
1053369660 | KATHLEEN DOYLE MD Individual | Pediatrics | 2825 HUNTERS TRL 1ST FLOOR PORTAGE, WI 53901 (608) 742-7161 |
1821055583 | BRADLEY K SCHNEE MD Individual | Family Medicine | 2825 HUNTERS TRL PORTAGE, WI 53901 (608) 742-7161 |
1346298205 | DAVID D GREGORY MD Individual | Family Medicine | 2825 HUNTERS TRL PORTAGE, WI 53901 (608) 724-7161 |
1720036064 | ELIZABETH R STRABEL MD Individual | Family Medicine | 2825 HUNTERS TRL 1ST FLOOR PORTAGE, WI 53901 (608) 742-7161 |
1770938771 | LAURA E BALLWEG APNP Individual | Nurse Practitioner | 2825 HUNTERS TRL PORTAGE, WI 53901 (608) 742-7161 |
1053803114 | MADELEINE M HACKER OD Individual | Optometrist | 2825 HUNTERS TRL PORTAGE, WI 53901 (608) 742-5522 |
1427085679 | DEAN HEALTH SYSTEMS, INC. Organization | Durable Medical Equipment & Medical Supplies | 2825 HUNTERS TRL LOWER LEVEL PORTAGE, WI 53901 (608) 742-5522 |
1760593545 | DEAN HEALTH SYSTEMS, INC Organization | Durable Medical Equipment & Medical Supplies | 2825 HUNTERS TRL 2ND FLOOR PORTAGE, WI 53901 (608) 742-1063 |
1992894786 | KARI JOYCE ALEXANDER PA Individual | Physician Assistant | 2825 HUNTERS TRL PORTAGE, WI 53901 (608) 742-7161 |
1265455711 | DR. SARAH M HAROLDSON MD Individual | Family Medicine | 2825 HUNTERS TRL PORTAGE, WI 53901 (608) 742-7161 |
1942743281 | RACHAEL B BOOTH APNP Individual | Nurse Practitioner | 2825 HUNTERS TRL PORTAGE, WI 53901 (608) 742-7161 |
1134187446 | GERALD L KRUMPOS MD Individual | Family Medicine | 2825 HUNTERS TRL PORTAGE, WI 53901 (608) 742-7161 |
1023054137 | ANDREA J LANGAN APNP Individual | Nurse Practitioner | 2825 HUNTERS TRL PORTAGE, WI 53901 (608) 742-7161 |
1477548949 | DR. PAUL B YOUNG M.D. Individual | Pediatrics | 2825 HUNTERS TRL PORTAGE, WI 53901 (608) 742-7161 |
1497792113 | THADDEUS C WHITING DO Individual | Family Medicine | 2825 HUNTERS TRL PORTAGE, WI 53901 (608) 742-7161 |
1336122506 | DARCY L STEINHORST PA-C Individual | Physician Assistant | 2825 HUNTERS TRL PORTAGE, WI 53901 (608) 742-7161 |
1689152068 | DR. TODD JAMES CASON DO Individual | Pediatrics | 2825 HUNTERS TRL PORTAGE, WI 53901 (608) 742-7161 |
1356399208 | ANTONIO ESCOBEDO-MORSE MD Individual | Family Medicine | 2825 HUNTERS TRL PORTAGE, WI 53901 (608) 742-7161 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1437132669, enumerated in the NPI registry as an "individual" on November 22, 2005
The provider is located at 2825 Hunters Trl Portage, Wi 53901 and the phone number is (608) 742-7161
The provider's speciality is Physician Assistant with taxonomy code 363A00000X
The provider has more than 21 years of experience. He graduated from University Of Wisconsin School Of Medicine in 2005.
The provider might be accepting Accepts: Anthem Blue Cross and Blue Shield, Dean Health. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
Yes, as of June 20, 2025 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a beneficiary the provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
Medicare beneficiaries should expect a typical cost of $82.92 with an average copayment of $20.73 for new patient appointments. Established patients should expect a typical charge of $67.37 and an average copayment of 16.84. Please review your insurance plan or contact the provider directly to determine your specific costs.
The most common procedures or services performed by this practitioner are: Administration of influenza virus vaccine, Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit, Complete blood cell count (red cells, white blood cell, platelets), automated test, Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count, Established patient office or other outpatient visit, 20-29 minutes, Established patient office or other outpatient visit, 30-39 minutes, Fee covid-19 vac 13 res, Influenza vaccine, quadrivalent inactivated, 0.5 ml dosage, Insertion of needle into vein for collection of blood sample, Manual urinalysis test with examination using microscope, automated, Red blood count, automated test, Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report, Testing for presence of drug, read by instrument assisted observation and Transitional care management services for problem of high complexity.
The practitioner is affiliated to the following hospital(s): DIVINE SAVIOR HEALTHCARE, SSM HEALTH ST CLARE HOSPITAL - BARABOO and SSM HEALTH ST MARY'S HOSPITAL - MADISON. Hospital affiliations are identified through self-reporting data and service claims based on the place of service.
This NPI record was last updated on November 22, 2005. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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