GREEN BAY EMERGENCY PHYSICIANS, LLC (NPI# 1083662712) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083662712 |
| Entity Type | Organization |
| Organization Name | GREEN BAY EMERGENCY PHYSICIANS, LLC |
| Practice Address |
1726 Shawano Ave Green Bay WI 54303-3216 |
| Mailing Address |
111 E Wisconsin Ave Suite 2000 Milwaukee WI 53202-4815 |
| Practice Telephone | 4142906718 |
| Practice Fax Number | 4142906755 |
| Mailing Telephone | 4142906718 |
| Mailing Fax Number | 4142906755 |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2019-08-28 |
| Authorized Official Name | KATHLEEN KONDAS (OFFICER) |
| Authorized Official Telephone | 4142906718 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 207P00000X | Emergency Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 32875300 | 05 | |
| WI | WEA | 120003951 | 01 |
| WI | OWCP | 137598401 | 01 |
| WI | MEDICARE RAILROAD | CI8038 | 01 |
| WI | FEDERAL BLACK LUNG PROGRA | 020151500 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588612212 | Green Bay Emergency Physicians, LLC | Physician Assistant | 835 S Van Buren St, Green Bay, WI 54301-3526 | 2006-05-05 |
| Street Address |
1726 SHAWANO AVE |
| City | GREEN BAY |
| State | WI |
| Zip Code | 54303-3216 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356324990 | Thomas M. Farley | Anesthesiology | 1726 Shawano Ave, Green Bay, WI 54303-3216 | 2005-11-29 |
| 1265048805 | Hillary Ann Bashaw | Nurse Practitioner | 1726 Shawano Ave, Green Bay, WI 54303-3216 | 2020-09-18 |
| 1043828387 | St Mary's Hospital Medical Center of Green Bay Inc.-hospital Sisters | Clinical Medical Laboratory | 1726 Shawano Ave, Green Bay, WI 54303-3282 | 2020-07-22 |
| 1750930079 | Jenna Mae Spude | Nurse Practitioner | 1726 Shawano Ave, Green Bay, WI 54303-3216 | 2019-09-09 |
| 1215423504 | Matthew James Dolan | Physician Assistant | 1726 Shawano Ave, Green Bay, WI 54303 | 2018-07-10 |
| 1013430073 | Whitney Jo Brusich | Physician Assistant | 1726 Shawano Ave, Green Bay, WI 54303-3216 | 2017-07-21 |
| 1720510043 | Christina R Mestelle | Physical Therapist | 1726 Shawano Ave, Green Bay, WI 54303 | 2017-03-28 |
| 1407231178 | Ahmed Farouk Mohammed | Internal Medicine | 1726 Shawano Ave, Green Bay, WI 54303-3216 | 2015-07-23 |
| 1184004236 | St. Vincent Hospital-hospital Sisters-third Order of St. Francis | Internal Medicine | 1726 Shawano Ave, Green Bay, WI 54303-3216 | 2015-06-04 |
| 1629468343 | Lynn Wilson | Nurse Practitioner | 1726 Shawano Ave, Green Bay, WI 54303-3216 | 2015-02-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952921033 | Ashley Marie Vandermoss | Social Worker | 1601 W Mason Street, Green Bay, WI 54303 | 2020-04-20 |
| 1598307423 | Jean Marie Castaneda | Case Manager/Care Coordinator | 2517 N. Court, Green Bay, WI 54303 | 2019-10-11 |
| 1215579552 | Integrated Treatment Centers, LLC | Clinic/Center | 2311 W Mason Street, Green Bay, WI 54303 | 2019-10-08 |
| 1003460551 | Affordable Dentures & Implants - Green Bay, S.c. | Dentist | 1800-c W. Mason Street, Green Bay, WI 54303 | 2019-08-01 |
| 1164940375 | Kaeley Rae Blaney | Student in an Organized Health Care Education/Training Program | 2088 Memorial Drive #208, Green Bay, WI 54303 | 2017-09-07 |
| 1518498047 | Treatment Providers LLC | Clinic/Center | 2731 N Packerland Dr Ste A, Green Bay, WI 54303 | 2017-03-26 |
| 1851840565 | Back To Balance Chiropractic, LLC | Chiropractor | 110 Packerland Drive, Suite B, Green Bay, WI 54303 | 2016-09-23 |
| 1710361001 | Matthew Lemay | Acupuncturist | 727 E Walnut, Suite B2, Green Bay, WI 54303 | 2015-07-16 |
| 1144600149 | Carrie Jean Banaszak | Counselor | 1039 Mason Street, Green Bay, WI 54303 | 2015-06-04 |
| 1174921993 | Kensey Meyer | Occupational Therapy Assistant | 1555 Dousman Road, Seymour, WI 54303 | 2014-12-10 |
| Find all providers in zip 54303 | ||||
| Taxonomy Code | 207P00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: mofified source] - Additional Resources: American Board of Emergency Medicine, 2007. http://www.abem.org/public/; American Osteopathic Board of Emergency Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437512613 | Jacob Tyler Clark | Emergency Medicine | 1035 Kepler Dr, Green Bay, WI 54311-8320 | 2016-04-04 |
| 1346275344 | William H Benn | Emergency Medicine | 2502 S Ashland Ave, Green Bay, WI 54304-5252 | 2006-07-11 |
| 1326090697 | Richard L Erdman | Emergency Medicine | 725 S Webster Ave, Green Bay, WI 54301-3500 | 2006-05-16 |
| 1063953313 | Daniel James Miller | Emergency Medicine | 2845 Greenbrier Rd, Green Bay, WI 54311-6519 | 2017-03-19 |
| 1922412279 | Kevin S. Dougherty | Emergency Medicine | 1726 Shawano Ave, Green Bay, WI 54303-3216 | 2014-06-15 |
| 1215355607 | William J Wagner | Emergency Medicine | 2845 Greenbrier Rd, Green Bay, WI 54311-6519 | 2014-04-02 |
| 1013352582 | Katie Lynn Lloyd | Emergency Medicine | 2845 Greenbrier Rd, Green Bay, WI 54311-6519 | 2013-05-09 |
| 1881951838 | Robert Paul Zemple | Emergency Medicine | 2845 Greenbrier Rd, Green Bay, WI 54311-6519 | 2012-04-16 |
| 1295021079 | Katrina Lynn Destree | Emergency Medicine | 2845 Greenbrier Rd, Green Bay, WI 54311-6519 | 2011-06-21 |
| 1962638064 | Christopher Britt Kolar | Emergency Medicine | 835 S Van Buren St, Green Bay, WI 54301-3526 | 2009-06-03 |
| Find all providers in GREEN BAY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.