NPIMap

Organization Active NPI

St Mary'S Hospital Medical Center of Green Bay Inc.-Hospital Sisters

  • Clinical Medical Laboratory
  • Green Bay, WI
National Provider Identifier
1043828387
Registry record updated Dec 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
ST MARY'S HOSPITAL MEDICAL CENTER OF GREEN BAY INC.-HOSPITAL SISTERS
Practice address
1726 Shawano Ave
Green Bay, WI 54303-3282
Phone
(920) 498-4200
NPI assigned
Jul 22, 2020
Organization subpart
Yes
Parent organization
ST MARY'S HOSPITAL MEDICAL CENTER OF GREEN BAY INC.-HOSPITAL SISTERSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 22, 2021

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

Authorized official

Name
Brian Charlier
Title
Ceo/President
Phone
(920) 676-1148

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

1726 Shawano Ave
Green Bay, WI 54303-3282

Mailing address

1726 Shawano Ave
Green Bay, WI 54303-3282
Phone (920) 498-4200

Other names 1

  • St. Mary's Hospital Outpatient Lab Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address stvincent_stmary_stnicholas_stclare@ewd.direct.hshs.org Direct

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
52D0395075St Marys Hospital Laboratory1726 Shawano Ave, Green Bay, WI 54303AccreditationFeb 27, 2027
52D0990491HSHS St Vincent Hospital Cancer Centers1726 Shawano Ave, Green Bay, WI 54303ComplianceApr 7, 2028

National Provider Directory

National Provider Directory
Tax ID family
St Mary'S Physician Service2 organizations share this tax ID, including this one
Part of
St Mary'S Physician Service

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1595376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640131200000",
    "number": "1043828387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1726 SHAWANO AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543033282",
            "telephone_number": "920-498-4200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1726 SHAWANO AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543033282",
            "telephone_number": "920-498-4200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST MARY'S HOSPITAL MEDICAL CENTER OF GREEN BAY INC.-HOSPITAL SISTERS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST MARY'S HOSPITAL MEDICAL CENTER OF GREEN BAY INC.-HOSPITAL SISTERS",
        "enumeration_date": "2020-07-22",
        "last_updated": "2021-12-22",
        "certification_date": "2021-12-22",
        "status": "A",
        "authorized_official_last_name": "CHARLIER",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "920-676-1148"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "stvincent_stmary_stnicholas_stclare@ewd.direct.hshs.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "1726 Shawano Ave",
            "city": "Green Bay",
            "state": "WI",
            "country_code": "US",
            "postal_code": "543033216",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "St. Mary's Hospital Outpatient Lab",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St. Mary's Hospital Outpatient Lab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Dec 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.