PREVEA CLINIC, INC. (NPI# 1306869276) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306869276 |
| Entity Type | Organization |
| Organization Name | PREVEA CLINIC, INC. |
| Other Organization Name | PREVEA HEALTH |
| Practice Address |
2710 Executive Dr Green Bay WI 54304-5496 |
| Mailing Address |
Po Box 19070 Prevea Health Green Bay WI 54307-9070 |
| Practice Telephone | 9204964700 |
| Practice Fax Number | 9204964705 |
| Mailing Telephone | 9204964700 |
| Mailing Fax Number | 9204964705 |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2009-06-25 |
| Authorized Official Name | ASHOK N RAI (PRESIDENT/CEO) |
| Authorized Official Telephone | 9204964700 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207K00000X | Allergy & Immunology | Allopathic & Osteopathic Physicians | ||
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians | ||
| N | 207RG0100X |
Internal Medicine Specialization: Gastroenterology |
Allopathic & Osteopathic Physicians | ||
| N | 207RI0200X |
Internal Medicine Specialization: Infectious Disease |
Allopathic & Osteopathic Physicians | ||
| N | 207RP1001X |
Internal Medicine Specialization: Pulmonary Disease |
Allopathic & Osteopathic Physicians | ||
| N | 207V00000X | Obstetrics & Gynecology | Allopathic & Osteopathic Physicians | ||
| N | 207VX0201X |
Obstetrics & Gynecology Specialization: Gynecologic Oncology |
Allopathic & Osteopathic Physicians | ||
| N | 207W00000X | Ophthalmology | Allopathic & Osteopathic Physicians | ||
| N | 207X00000X | Orthopaedic Surgery | Allopathic & Osteopathic Physicians | ||
| N | 207Y00000X | Otolaryngology | Allopathic & Osteopathic Physicians | ||
| N | 207ZP0102X |
Pathology Specialization: Anatomic Pathology & Clinical Pathology |
Allopathic & Osteopathic Physicians | ||
| N | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians | ||
| N | 2080P0201X |
Pediatrics Specialization: Pediatric Allergy/Immunology |
Allopathic & Osteopathic Physicians | ||
| Y | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 32704600 | 05 |
| Other Name | Type Code |
|---|---|
| Prevea Health | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588110969 | Prevea Clinic, Inc. | Obstetrics & Gynecology | 2449 County Highway I, Chippewa Falls, WI 54729-4410 | 2016-08-26 |
| 1558508119 | Prevea Clinic, Inc. | Durable Medical Equipment & Medical Supplies | 101 School Creek Trl, Luxemburg, WI 54217-1095 | 2009-01-19 |
| 1205965332 | Prevea Clinic, Inc. | Durable Medical Equipment & Medical Supplies | 835 S Van Buren St, Green Bay, WI 54301-3526 | 2007-03-05 |
| 1023147154 | Prevea Clinic, Inc. | Durable Medical Equipment & Medical Supplies | 900 S Webster Ave, Green Bay, WI 54301-3508 | 2007-03-05 |
| 1144359431 | Prevea Clinic, Inc. | Durable Medical Equipment & Medical Supplies | 760 Pilgrim Way, Green Bay, WI 54304-5263 | 2007-03-05 |
| 1396874582 | Prevea Clinic, Inc. | Durable Medical Equipment & Medical Supplies | 1686 Eisenhower Rd, De Pere, WI 54115-8145 | 2007-03-05 |
| 1083743272 | Prevea Clinic, Inc. | Durable Medical Equipment & Medical Supplies | 620 Smith Ave, Oconto, WI 54153-1080 | 2007-03-05 |
| 1780713339 | Prevea Clinic, Inc. | Durable Medical Equipment & Medical Supplies | 620 Smith Ave, Oconto, WI 54153-1080 | 2007-03-02 |
| 1326177999 | Prevea Clinic, Inc. | Durable Medical Equipment & Medical Supplies | 958 Foote St, Seymour, WI 54165-1044 | 2007-03-02 |
| Street Address |
2710 EXECUTIVE DR |
| City | GREEN BAY |
| State | WI |
| Zip Code | 54304-5496 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285613638 | St Vincent Hospital-hospital Sisters-third Order of St Francis | Family Medicine | 2710 Executive Dr, Green Bay, WI 54304-5496 | 2006-01-13 |
| 1578047452 | Aaron Witt | Physician Assistant | 2710 Executive Dr, Green Bay, WI 54304-5496 | 2018-09-18 |
| 1932650017 | St. Vincent Hospital of The Hospital Sisters-third Order of St. Franci | Physician Assistant | 2710 Executive Dr, Green Bay, WI 54304-5496 | 2016-10-24 |
| 1114389087 | Kayla Branam | Registered Nurse | 2710 Executive Dr, Green Bay, WI 54304-5496 | 2016-03-22 |
| 1194748061 | Prevea Regional Services, Inc. | Family Medicine | 2710 Executive Dr, Green Bay, WI 54304-5496 | 2006-07-25 |
| 1548298169 | Laura M Nelson | Internal Medicine | 2710 Executive Dr, Green Bay, WI 54304-5496 | 2006-06-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689196255 | Kristen Ashley Haltom | Registered Nurse | 2979 Allied St Suite C, Green Bay, WI 54304 | 2017-07-14 |
| 1649671421 | Heather Marie Novak | Counselor | 2979 Allied St Unit C, Green Bay, WI 54304 | 2014-09-11 |
| 1356777684 | Nathan Weir | Specialist/Technologist | 1265 Lombardi Avenue, Green Bay, WI 54304 | 2013-09-18 |
| 1922349927 | John W Hartman | Internal Medicine | 916 Willard Dr, Suite 200, Green Bay, WI 54304 | 2013-03-15 |
| 1447551379 | Citralina M Haruo | Community Health Worker | 1110 11th Avenue, Green Bay, WI 54304 | 2010-11-09 |
| 1497061352 | Daniel James Gustin | Pharmacist | 1109 Lombardi Ave, Green Bay, WI 54304 | 2010-08-28 |
| 1316259898 | Karen A Detrick | Occupational Therapy Assistant | 1040 Pilgram Way, Woodside Senior Communities, Green Bay, WI 54304 | 2010-07-13 |
| 1861667362 | Planned Parenthood of Wi, Inc | Non-Pharmacy Dispensing Site | 2605 S. Oneida St. Suite 107, Green Bay, WI 54304 | 2008-04-25 |
| 1891967303 | Kimberley M Welk | Marriage & Family Therapist | 926 Willard Dr Ste 136, Green Bay, WI 54304 | 2008-03-25 |
| 1750563698 | Richard Lawrence Beyer | Hearing Instrument Specialist | 2154 S Ridge Rd, Green Bay, WI 54304 | 2007-12-03 |
| Find all providers in zip 54304 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922349927 | John W Hartman | Internal Medicine | 916 Willard Dr, Suite 200, Green Bay, WI 54304 | 2013-03-15 |
| 1891061446 | Riley O'hara Meyer | Internal Medicine | 401 N. Washington St., #315, Green Bay, WI 54301 | 2012-03-28 |
| 1811121023 | Kevin Peter Rosteing | Internal Medicine | 2126 William Francis Ct, Green Bay, WI 54311-6352 | 2009-05-04 |
| 1225118235 | Imran R Sheikh | Internal Medicine | 1320 Crystal Cove Trl, Apt 2, Green Bay, WI 54311-4292 | 2006-10-16 |
| 1952418386 | Gowdar Sadishiv Murthy | Internal Medicine | 3000 Ravine Way, Green Bay, WI 54301-1507 | 2006-08-23 |
| 1265452296 | Sheila Waldrop Thiel | Internal Medicine | 2845 Greenbrier Rd Ste 120, Green Bay, WI 54311-6519 | 2006-07-20 |
| 1780644666 | Vijaya K Munagala | Internal Medicine | 744 S Webster Ave Fl 2, Green Bay, WI 54301-3505 | 2006-03-24 |
| 1992774160 | Thomas Joseph Leonard | Internal Medicine | 2763 Manitowoc Rd, Suite B, Green Bay, WI 54311-6633 | 2006-03-17 |
| 1497721054 | Patricia Elizabeth Sias | Internal Medicine | 1715 Dousman St., Green Bay, WI 54303-3211 | 2006-02-24 |
| 1780671792 | Kathleen Ann Mcdougal | Internal Medicine | 3021 Voyager Dr, Green Bay, WI 54311-8303 | 2005-10-04 |
| 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.