Kevin L Mortara, MD

Primary specialty

Hematology & Oncology PhysicianTaxonomy code 207RH0003X

License

48997-20 Issued in WI

Practice address

1580 Commanche Ave
Green Bay, WI 54313-5751

Phone

(920) 435-8326

Fax

(920) 430-4659

NPI assigned

Oct 27, 2005

Last updated

Jun 12, 2014By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kmortara135598@direct.thedacare.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Bellin Memorial Hospital Inc

  dba Bellin Health Algoma

  • Rural Health Clinic/Center
  • Algoma, WI
  • NPI 1609838473
  Medicare reassignment NPD
• Oconto Hospital & Medical Center Inc

  dba Emplify Health Oconto Hospital

  • Critical Access Hospital
  • Oconto, WI
  • NPI 1356373302
  Medicare reassignment NPD
• Bellin Memorial Hospital Inc

  dba Bellin Health

  • Family Medicine Physician
  • Green Bay, WI
  • NPI 1033172390
  NPD
• Bellin Memorial Hospital Inc.

  • General Acute Care Hospital
  • Green Bay, WI
  • NPI 1891740585
  NPD
• Oconto Hospital & Medical Center Inc

  dba Bellin Health Suring

  • Rural Health Clinic/Center
  • Suring, WI
  • NPI 1104418037
  NPD
• Oconto Hospital & Medical Center, Inc.

  dba Emplify Health Oconto Clinic

  • Rural Health Clinic/Center
  • Oconto, WI
  • NPI 1609018589
  NPD

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

{
    "created_epoch": "1130371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402531200000",
    "number": "1033109210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1580 COMMANCHE AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543135751",
            "telephone_number": "920-435-8326",
            "fax_number": "920-430-4659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1580 COMMANCHE AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543135751",
            "telephone_number": "920-435-8326",
            "fax_number": "920-430-4659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORTARA",
        "first_name": "KEVIN",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-27",
        "last_updated": "2014-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "WI",
            "license": "48997-20",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Roland P Moreno, MD
• Matas Morkevicius, M.D.
• Jami M Morley, APNP
• Marianne E Morris, BA
• William G Morrissey, MD
• Kristina Ann Mortell, APNP
• Olivia Ann Morzenti, RDH
• Regan Moseng
• Amber Moser, SACIT
• Simmi Mosier, M.A., CCC-SLP

• Hematology & Oncology Physician in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Hematology & Oncology Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.