Active NPI
Damon Krupela, PA-C
- Physician Assistant
- Green Bay, WI
National Provider Identifier
1053508465
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 2201
- Practice address
- 2845 Greenbrier Rd
Green Bay, WI 54311-6519 - Phone
- (920) 288-4060
- Fax
- (920) 288-4067
- NPI assigned
- Sep 29, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 2201 | WI | Primary |
Addresses
Primary practice location
2845 Greenbrier Rd
Green Bay, WI 54311-6519
Mailing address
2845 Greenbrier Rd
PO Box 8900
Green Bay, WI 54308-8900
Phone (920) 288-4060
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2201 | WI | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1191024000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1257984000000",
"number": "1053508465",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2845 GREENBRIER RD",
"address_2": "PO BOX 8900",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543088900",
"telephone_number": "920-288-4060",
"fax_number": "920-288-4067"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2845 GREENBRIER RD",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543116519",
"telephone_number": "920-288-4060",
"fax_number": "920-288-4067"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRUPELA",
"first_name": "DAMON",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-09-29",
"last_updated": "2009-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WI",
"license": "2201",
"primary": true
}
],
"identifiers": [],
"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 Nov 12, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.