Unknown Individual – General Practice Physician, NPI 1669467882
General Practice Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
62 GENERAL PRACTICE in WI
Provider Addresses for Unknown Individual
W12802 COUNTY HIGHWAY A
BOWLER, WI 54416
Phone: (715) 793-4144
Fax: (715) 793-5062
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2003-12-08
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20031208000978 | I | General Practice | WI | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 124 | 70 | $0 |
| 36415 | Insertion of needle into vein for collection of blood sample | 117 | 45 | $0 |
| 80048 | Blood test, basic group of blood chemicals (calcium, total) | 62 | 34 | $0 |
| 85027 | Complete blood cell count (red cells, white blood cell, platelets), automated test | 41 | 18 | $0 |
| 83036 | Hemoglobin a1c level | 27 | 18 | $0 |
Insurance plans in this area (ZIP 54416)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| GENERAL PRACTICE | WI | 83036 | Hemoglobin A1C level | 78 | 45 |
| GENERAL PRACTICE | WI | 85610 | Blood test, clotting time | 127 | 13 |
| GENERAL PRACTICE | WI | 97001 | Physical therapy evaluation | 16 | 13 |
| GENERAL PRACTICE | WI | 97140 | Manual (physical) therapy techniques to 1 or more regions, each 15 minutes | 73 | 12 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Internal Medicine | WI | |
| - | WI | |
| Physical Therapist In Private Practice | WI | |
| Family Practice | WI | |
| C H I R O P R A C T I C | WI | |
| Nurse Practitioner | WI | |
| Nurse Practitioner | WI | |
| Nurse Practitioner | WI | |
| - | MI | |
| Family Practice | WI |
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