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MAYRA A BETANCOURT PONCE MD
NPI 1154121002
Student in an Organized Health Care Education/Training Program in La Crosse, WI

Active since March 18, 2025PECOS Enrolled
1836 SOUTH AVE, LA CROSSE, WI 54601(608) 782-7300 Get Directions Write a Review

NPPES record last updated: July 9, 2026. Verified against the NPPES registry weekly; last sync: September 06, 2026.

Record update history: Jul 9, 2026, Apr 3, 2026, Mar 18, 2025 (3 updates tracked since 2025).

About Mayra A Betancourt Ponce Md NPPES

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

MAYRA A BETANCOURT PONCE MD (NPI 1154121002) is an individual student in an organized health care education/training program in La Crosse, Wisconsin and active in the NPI registry since March 2025. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1154121002
Entity TypeIndividualFemale
Primary Taxonomy390200000X
Provider Legal NameMAYRA A BETANCOURT PONCECredential: MD
Location Address1836 SOUTH AVELa Crosse, WI 54601-5429
Mailing Address1836 South AveLa Crosse, WI 54601-5429 · (608) 782-7300
Phone(608) 782-7300
Sole ProprietorNo
Enumeration DateMarch 18, 2025
Last NPPES UpdateJuly 9, 20263 updates tracked since enumeration
NPPES CertifiedJuly 9, 2026
✔ NPI 1154121002 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
1836 SOUTH AVE, La Crosse, WI 54601
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mayra A Betancourt Ponce Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JEFFREY BRIAN TROHKIMOINEN M.D.
Anesthesiology
1836 SOUTH AVE, GUNDERSEN CLINIC, LTD.
LA CROSSE, WI 54601
La Crosse County (608) 775-2031
JESSICA E THESING CRNA
Nurse Anesthetist, Certified Registered
1836 SOUTH AVE
LA CROSSE, WI 54601
La Crosse County (608) 782-7300
DR. MICHAEL DAVID SMITH PSY.D.
Psychologist
1836 SOUTH AVE
LA CROSSE, WI 54601
La Crosse County (608) 782-7300
JESSICA MAE RASMUSSEN
Surgery
1836 SOUTH AVE
LA CROSSE, WI 54601
La Crosse County (608) 782-7300
JULIE SONSALLA APNP
Nurse Practitioner (Adult Health)
1836 SOUTH AVE
LA CROSSE, WI 54601
La Crosse County (608) 782-7300
LAURA KLINGBEIL
Orthopaedic Surgery
1836 SOUTH AVE
LA CROSSE, WI 54601
La Crosse County (608) 782-7300
SUSAN CAROL SORRENTINO RN
Registered Nurse (Addiction (Substance Use Disorder))
1836 SOUTH AVE
LA CROSSE, WI 54601
La Crosse County (608) 782-7300
NAOMI MUTHONI RUIRU APNP
Nurse Practitioner (Family)
1836 SOUTH AVE
LA CROSSE, WI 54601
La Crosse County (608) 782-7300

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 Mayra Betancourt Ponce's NPI number?

The NPI number for Mayra Betancourt Ponce is 1154121002. It was assigned to this individual provider in the NPPES registry on March 18, 2025.

Where is Mayra Betancourt Ponce located?

Mayra Betancourt Ponce practices at 1836 South Ave, La Crosse, WI 54601. The listed phone number is (608) 782-7300.

What is Mayra Betancourt Ponce's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Mayra Betancourt Ponce enrolled in Medicare?

Yes. Mayra Betancourt Ponce is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Mayra Betancourt Ponce was last updated on July 9, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months 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.