CHARLES R. HERON, M.D., S.C. (NPI# 1427005107) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1427005107 |
| Entity Type | Organization |
| Organization Name | CHARLES R. HERON, M.D., S.C. |
| Practice Address |
1726 Shawano Ave Green Bay WI 54303-3216 |
| Mailing Address |
225 S Executive Dr Brookfield WI 53005-4266 |
| Practice Telephone | 9204984200 |
| Mailing Telephone | 2627874026 |
| Enumeration Date | 2006-05-28 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | CHARLES R HERON (AUTHORIZED OFFICIAL) |
| Authorized Official Telephone | 9204984200 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 207LP2900X |
Anesthesiology Specialization: Pain Medicine |
Allopathic & Osteopathic Physicians | ||
| X | 207L00000X | Anesthesiology | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 32081000 | 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 |
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| 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 | 207LP2900X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Anesthesiology |
| Specialization | Pain Medicine |
| An anesthesiologist who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic and/or cancer pain in both hospital and ambulatory settings. Patient care needs are also coordinated with other specialists. |
| 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 Anesthesiology, 2007. http://www.theaba.org/; American Osteopathic Board of Anesthesiology, 2007, http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Anesthesiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Anesthesiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215003082 | Millenium Anesthesiologists, Ltd. | Anesthesiology | 1726 Shawano Ave, Green Bay, WI 54303-3216 | 2006-11-25 |
| 1932156965 | America's Anesthesiologist, S.c. | Anesthesiology | 1726 Shawano Ave, Green Bay, WI 54303-3216 | 2006-05-27 |
| 1023065836 | Green Bay Anesthesia Assoc. Sc | Anesthesiology | 835 S Van Buren St, Green Bay, WI 54301-3526 | 2006-05-27 |
| 1831145291 | Geetha S. Murthy M.d., S.c. | Anesthesiology | 1726 Shawano Ave, Green Bay, WI 54303-3216 | 2006-05-26 |
| 1992751275 | John H. Danner IIi, M.d., S.c. | Anesthesiology | 744 S Webster Ave, Green Bay, WI 54301-3505 | 2006-05-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700309101 | Wisconsin Interventional Pain Solutions Sc | Anesthesiology | 2500 N Mayfair Rd Ste 325, Wauwatosa, WI 53226-1443 | 2017-07-18 |
| 1528402781 | Aspen Wellness and Pain Medicine Center | Anesthesiology | W176n9830 Rivercrest Dr Ste 102, Germantown, WI 53022-4692 | 2013-04-18 |
| 1720307283 | Andres Fernando Quitzon Jr. | Anesthesiology | 2245 W Brantwood Ave, Milwaukee, WI 53209 | 2010-05-24 |
| 1861688418 | Horizon Interventional Pain Physicians, Sc | Anesthesiology | 7071 S 13th St, Suite # 102, Oak Creek, WI 53154-1466 | 2007-09-18 |
| 1992800791 | Interventional Pain Specialists of Wisconsin, Sc | Anesthesiology | 2021 Cenex Dr, Suite J, Rice Lake, WI 54868-1891 | 2006-09-14 |
| 1275500910 | Saleem Awan | Anesthesiology | 4570 S 27th St, Milwaukee, WI 53221-2145 | 2006-03-01 |
| 1871560581 | Yogendra Bharat | Anesthesiology | 2500 W Layton Ave Ste 170, Milwaukee, WI 53221-5433 | 2006-03-01 |
| 1871569830 | Roman Berezovski | Anesthesiology | 4131 W. Loomis Rd., Ste 300, Greenfield, WI 53221-2059 | 2006-02-28 |
| 1598762841 | Nathan C Meloy | Anesthesiology | 2700 W 9th Ave, Suite 205, Oshkosh, WI 54904-7247 | 2005-07-01 |
| 1922457803 | Holly Haberman | Anesthesiology | 710 Riverside Dr, Waupaca, WI 54981-1941 | 2016-06-10 |
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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.