DR. MARK R BOETTCHER DDS
NPI 1083826390
Dentist - General Practice in Brookfield, WI

Q: What is Mark Boettcher's NPI number?

The NPI number for Mark Boettcher is 1083826390. It was assigned to this individual provider in the NPPES registry on May 7, 2007.

Q: What is Mark Boettcher's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Q: Is Mark Boettcher enrolled in Medicare?

No. Mark Boettcher has opted out of Medicare through July 12, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

Q: When was this NPI record last updated?

The NPPES record for Mark Boettcher was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since May 07, 2007Opted out of Medicare · through Jul 12, 2028

16905 WEST WISCONSIN AVE, BROOKFIELD, WI 53005(262) 754-4480(262) 754-4470 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: September 20, 2026.

On this page

About Dr. Mark R Boettcher Dds NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. MARK R BOETTCHER DDS (NPI 1083826390) is an individual general practice provider in Brookfield, Wisconsin, licensed in Wisconsin (5001903015) and active in the NPI registry since May 2007. He has opted out of Medicare through July 12, 2028 and remains eligible to order and refer.

NPPES Registry Identity

NPI1083826390

Entity TypeIndividualMale

Primary Taxonomy1223G0001X

Provider Legal NameDR. MARK R BOETTCHERCredential: DDS

Location Address16905 WEST WISCONSIN AVEBrookfield, WI 53005-5729

Mailing Address16905 West Wisconsin AveBrookfield, WI 53005-5729 · (262) 754-4480 · Fax (262) 754-4470

Phone(262) 754-4480

Fax(262) 754-4470

Sole ProprietorNo

Enumeration DateMay 7, 2007

Last NPPES UpdateJuly 8, 2007

✔ NPI 1083826390 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers

Taxonomy Code1223G0001X

License✔ Licensed in WI · 5001903015

Definition

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

16905 WEST WISCONSIN AVE, Brookfield, WI 53005

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Other Identifiers 1

Medicaid33363900WI

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Mark R Boettcher Dds has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from July 12, 2016 through July 12, 2028.

Opt-Out Effective DateJuly 12, 2016

Opt-Out In Effect ThroughJuly 12, 2028Opt-out affidavits renew automatically every two years unless cancelled

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 53005 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$82.92 typical visit price

range $53.90 – $163.24

Typical copayment $20.73 (range $13.47 – $40.81)

Most-billed visit code 99203

Established Patient

$67.37 typical visit price

range $17.40 – $133.76

Typical copayment $16.84 (range $4.35 – $33.44)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mark Boettcher's NPI number?

The NPI number for Mark Boettcher is 1083826390. It was assigned to this individual provider in the NPPES registry on May 7, 2007.

Where is Mark Boettcher located?

Mark Boettcher practices at 16905 West Wisconsin Ave, Brookfield, WI 53005. The listed phone number is (262) 754-4480.

What is Mark Boettcher's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Is Mark Boettcher enrolled in Medicare?

No. Mark Boettcher has opted out of Medicare through July 12, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Mark Boettcher was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.