STACI M KOTHBAUER CRNA
NPI 1225004757
Nurse Anesthetist, Certified Registered in Madison, WI
About Staci M Kothbauer Crna NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
STACI M KOTHBAUER CRNA (NPI 1225004757) is an individual nurse anesthetist, certified registered in Madison, Wisconsin, licensed in Wisconsin (13813430) and active in the NPI registry since February 2006. She is enrolled in Medicare PECOS, is affiliated with Ssm Health St Clare Hospital - Baraboo, and is a graduate of Other (2005).
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 1
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Staci M Kothbauer Crna is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignments
2Medicare enrollment records show Staci Kothbauer reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Madison, WI 53715
- Reassigned Medicare billing, Wisconsin enrollment
- 35 clinicians in this Medicare group
Madison, WI 53715
- Reassigned Medicare billing, Wisconsin enrollment
- 1,377 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Areas of Expertise CMS Part B claims
Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.
Hospital Affiliations CMS Care Compare 2
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
Ssm Health St Clare Hospital - Baraboo
Acute Care Hospitals · Baraboo, WISsm Health St Mary's Hospital - Madison
Acute Care Hospitals · Madison, WIPhysician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 53715 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
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.
MADISON, WI 53715
MADISON, WI 53715
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 Staci Kothbauer's NPI number?
The NPI number for Staci Kothbauer is 1225004757. It was assigned to this individual provider in the NPPES registry on February 24, 2006.
Where is Staci Kothbauer located?
Staci Kothbauer practices at 700 S Park St, Madison, WI 53715. The listed phone number is (608) 251-6100.
What is Staci Kothbauer's specialty?
The primary specialty registered for this NPI is Nurse Anesthetist, Certified Registered with taxonomy code 367500000X.
Is Staci Kothbauer enrolled in Medicare?
Yes. Staci Kothbauer is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organizations bill Medicare for Staci Kothbauer's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Staci Kothbauer reassigns Medicare benefits to 2 organizations: Ssm Health Care Of Wisconsin, Inc. (Madison, WI) and Dean Health Systems, Inc (Madison, WI). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Staci Kothbauer's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
Is Staci Kothbauer affiliated with any hospitals?
According to CMS data, Staci Kothbauer is affiliated with Ssm Health St Clare Hospital - Baraboo and Ssm Health St Mary's Hospital - Madison.
When was this NPI record last updated?
The NPPES record for Staci Kothbauer was last updated on December 4, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.
# Staci M Kothbauer, CRNA · NPI 1225004757
Nurse Anesthetist, Certified Registered physician in Madison, Wisconsin. Individual provider, active in the CMS NPPES registry since February 24, 2006.
## Identity
- **NPI:** 1225004757 (Entity type: Individual)
- **Enumerated:** February 24, 2006
- **Primary specialty:** Nurse Anesthetist, Certified Registered · taxonomy 367500000X
- **State license:** 13813430 (Wisconsin)
- **Sole proprietor:** No
## Practice location
- **Address:** 700 S PARK ST, Madison, WI 53715-1830
- **Phone:** (608) 251-6100 · **Fax:** (608) 258-5222
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): Ssm Health Care Of Wisconsin, Inc. (NPI 1184621211, Madison, WI); Dean Health Systems, Inc (NPI 1053358846, Madison, WI) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2005
## Record status
- **NPPES last updated:** December 4, 2020
- **Other identifiers:** Medicaid 1225004757 (WI)
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Source: [NPI Profile](https://npiprofile.com/npi/1225004757) · Data from the CMS NPPES public registry.