KIRK D SCATTERGOOD (NPI# 1790702652) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790702652 |
| Entity Type | Individual |
| Full Name | KIRK D SCATTERGOOD |
| Credential | MD |
| Practice Address |
2253 W Mason St Ste 100 Green Bay WI 54303-4706 |
| Mailing Address |
164 N Broadway Green Bay WI 54303-2728 |
| Practice Telephone | 9203277000 |
| Practice Fax Number | 9203277005 |
| Mailing Telephone | 9204909046 |
| Mailing Fax Number | 9203277005 |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2017-11-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207W00000X | Ophthalmology | 36086 | WI | Allopathic & Osteopathic Physicians |
| Y | 207WX0107X |
Ophthalmology Specialization: Retina Specialist |
36086 | WI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 32078200 | 05 |
| Street Address |
2253 W MASON ST STE 100 |
| City | GREEN BAY |
| State | WI |
| Zip Code | 54303-4706 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790720100 | Dianna L Bordewick | Ophthalmology | 2253 W Mason St Ste 100, Green Bay, WI 54303-4706 | 2006-06-19 |
| 1497220107 | Linda Thieme | Technician/Technologist | 2253 W Mason St Ste 100, Green Bay, WI 54303-4706 | 2018-10-09 |
| 1306075635 | Jacob A Kozisek | Optometrist | 2253 W Mason St Ste 100, Green Bay, WI 54303-4706 | 2009-07-08 |
| 1265623649 | Joseph Thomas Bergmann | Ophthalmology | 2253 W Mason St Ste 100, Green Bay, WI 54303-4706 | 2007-08-09 |
| 1932218005 | Wei-chuan Wang | Ophthalmology | 2253 W Mason St Ste 100, Green Bay, WI 54303-4706 | 2006-08-30 |
| 1003828740 | Brad J Lavallie | Optometrist | 2253 W Mason St Ste 100, Green Bay, WI 54303-4706 | 2006-08-12 |
| 1144241852 | Kevin P Wienkers | Ophthalmology | 2253 W Mason St Ste 100, Green Bay, WI 54303-4706 | 2006-07-21 |
| 1558381632 | Brian T Perkovich | Ophthalmology | 2253 W Mason St Ste 100, Green Bay, WI 54303-4706 | 2006-07-20 |
| 1235167537 | Mark T Duffy | Ophthalmology | 2253 W Mason St Ste 100, Green Bay, WI 54303-4706 | 2006-06-28 |
| 1568490829 | William J Foster | Ophthalmology | 2253 W Mason St Ste 100, Green Bay, WI 54303-4706 | 2006-06-28 |
| 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 | 207WX0107X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Ophthalmology |
| Specialization | Retina Specialist |
| An ophthalmologist who specializes in the diagnosis and treatment of vitreoretinal diseases. |
| Notes: Source: American Society of Retina Specialists, www.asrs.org [1/1/2017: new] - Additional Resources: American Academy of Ophthalmology, www.aao.org. Macula Society, www.maculasociety.org. Retina Society, www.retinasociety.org. Association of University Professors of Ophthalmology, www.aupo.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811253289 | Michael Edward Possin | Ophthalmology | 200 Theda Clark Medical Plz Ste 110, Neenah, WI 54956-2790 | 2012-04-10 |
| 1437164175 | Northeast Wisconsin Retina Associates Sc | Ophthalmology | 200 Theda Clark Plaza, Suite 110, Neenah, WI 54956-2790 | 2006-07-30 |
| 1700819281 | Rajeev Buddi | Ophthalmology | 200 Theda Clark Pl, Suite 110, Neenah, WI 54956 | 2006-07-08 |
| 1356640726 | Khalid S Kahook | Ophthalmology | 200 Theda Clark Plaza, Suite 110, Neenah, WI 54956-2790 | 2011-03-24 |
| 1679580070 | John P Rosculet | Ophthalmology | 200 Theda Clark Plaza, Suite 110, Neenah, WI 54956 | 2006-08-01 |
| 1922013671 | Charles Hejny | Ophthalmology | 200 Theda Clark Plaza, Suite 110, Neenah, WI 54956 | 2006-07-30 |
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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.