NPIMap

Organization Active NPI

Green Bay Anesthesia Assoc. SC

  • Anesthesiology Physician
  • Green Bay, WI
National Provider Identifier
1023065836
Registry record updated Sep 2, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
GREEN BAY ANESTHESIA ASSOC. SC
Practice address
835 S Van Buren St
Green Bay, WI 54301-3526
Phone
(920) 433-0111
NPI assigned
May 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Brian B Skaletski, M.D.NPI 1679557847
Title
Authorized Official
Phone
(920) 433-0111

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207L00000X Primary
Pain Medicine (Anesthesiology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207LP2900X

Addresses

Primary practice location

835 S Van Buren St
Green Bay, WI 54301-3526

Mailing address

225 S Executive Dr
Brookfield, WI 53005-4257
Phone (262) 787-4026

Other identifiers 1

IdentifierTypeStateIssuer
32797400MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041011000244 WI Part B Supplier - Clinic/Group Practice 4486613858 Receives reassigned benefits from 121 practitioners
Practice locations: Green Bay, WI

National Provider Directory

National Provider Directory

Locations

2595 Development Dr
Green Bay, WI 54311
Phone (920) 338-2120

Bin 88263
Milwaukee, WI 53288

Practitioners & affiliated clinicians

Practitioners 123

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 123

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314921600000",
    "number": "1023065836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 S EXECUTIVE DR",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530054257",
            "telephone_number": "262-787-4026",
            "fax_number": "262-782-6040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "835 S VAN BUREN ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543013526",
            "telephone_number": "920-433-0111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN BAY ANESTHESIA ASSOC. SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-27",
        "last_updated": "2011-09-02",
        "status": "A",
        "authorized_official_last_name": "SKALETSKI",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "920-433-0111",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32797400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.