Individual provider Active NPI

Shawn W Laibly, MD

  • Obstetrics & Gynecology Physician
  • Sturgeon Bay, WI
National Provider Identifier
1043322266
Registry record updated Apr 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
43278 Issued in WI
Practice address
323 S 18TH Ave
Sturgeon Bay, WI 54235-1401
Phone
(920) 746-0510
NPI assigned
Sep 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 43278 WI Primary

Addresses

Primary practice location

323 S 18TH Ave
Sturgeon Bay, WI 54235-1401

Mailing address

323 S 18TH Ave
Sturgeon Bay, WI 54235-1401
Phone (920) 746-0510

Other identifiers 1

IdentifierTypeStateIssuer
34081100MedicaidWI

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20051103000551 WI Practitioner - Obstetrics/Gynecology 6002834546 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
University of Minnesota Medical School, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Agnesian Healthcare IncGroup PAC ID 1658289624, 392 clinicians

Practice addresses (Care Compare)

608 W Brown St
Waupun, WI 53963-1702
Phone (920) 324-6800

Hospital & facility affiliations

  • Waupun Memorial Hospital Hospital, Waupun, WI, CCN 521327

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of the uterus1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Agnesian Healthcare Inc Obstetrics & Gynecology CurrentSince Aug 7, 2023 Accepting new patients
Agnesian Healthcare Inc CurrentSince Aug 7, 2023 Accepting new patients
Agnesian Healthcare, Inc Current Accepting new patients

Locations

130 Corporate Dr
Beaver Dam, WI 53916
Phone (920) 877-3102

210 Wisconsin American Dr
Fond du Lac, WI 54937
Phone (920) 907-7000

360 S Mountin Dr
Mayville, WI 53050
Phone (920) 387-2111

933 Newbury St
Ripon, WI 54971
Phone (920) 748-0430

620 W Brown St
Waupun, WI 53963
Phone (920) 324-5581

608 W Brown St
Waupun, WI 53963
Phone (920) 324-6800

Interoperability endpoints

  • Direct secure messaging: slaibly487555@direct-ehr-ssmhc.com

Organizations & group practices 3

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

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1157068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680480000000",
    "number": "1043322266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "323 S 18TH AVE",
            "city": "STURGEON BAY",
            "state": "WI",
            "postal_code": "542351401",
            "telephone_number": "920-746-0510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "323 S 18TH AVE",
            "city": "STURGEON BAY",
            "state": "WI",
            "postal_code": "542351401",
            "telephone_number": "920-746-0510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAIBLY",
        "first_name": "SHAWN",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-01",
        "last_updated": "2023-04-03",
        "certification_date": "2023-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "WI",
            "license": "43278",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34081100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sturgeon Bay, WI

Sources for this page

Verify at the official NPI Registry.