Individual provider Active NPI

Krista S Primley

  • Oral and Maxillofacial Surgery (Dentist)
  • Green Bay, WI
National Provider Identifier
1073013025
Registry record updated May 19, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
6001396 Issued in WI
Practice address
2581 Development Dr
Green Bay, WI 54311-4247
Phone
(920) 347-0400
Fax
(920) 347-0868
NPI assigned
Feb 16, 2018
Last updated
May 19, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 19, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X D14292 MN
Student in an Organized Health Care Education/Training Program 390200000X RES-30533 IA
Oral and Maxillofacial Surgery (Dentist) 1223S0112X 6001396 WI Primary

Addresses

Primary practice location

2581 Development Dr
Green Bay, WI 54311-4247

Mailing address

1035 Kepler Dr
Green Bay, WI 54311-8320
Phone (920) 490-9046

Other practice location 1

200 Hawkins Dr
Iowa City, IA 52242-1009
Phone (319) 356-7339

Other practice location 2

636 N 12th Ave
Sturgeon Bay, WI 54235-1249
Phone (920) 743-2001

Other practice location 3

930 Maritime Dr
Manitowoc, WI 54220-2961
Phone (920) 682-9121

Other practice location 4

8515 Eagle Point Blvd Ste 200
Lake Elmo, MN 55042-8624
Phone (651) 523-9950

Other practice location 5

515 Delaware St SE
Minneapolis, MN 55455
Phone (612) 624-8600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, WI2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20230914003226 MN Practitioner - Oral Surgery 1456607217 Reassigns benefits to 1 organization
I20240213000374 WI Practitioner - Oral SurgeryPractitioner - Maxillofacial Surgery 1456607217 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Oral SurgeryAlso: Maxillofacial Surgery
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Baycare Clinic LLPGroup PAC ID 4385554328, 197 clinicians

Practice addresses (Care Compare)

2581 Development Dr
Green Bay, WI 54311-4246
Phone (920) 347-0400

Merit-based Incentive Payment System (MIPS)

Final score
86.21 of 100Reported as group
Quality
78.54
Promoting interoperability
100
Improvement activities
40
Cost
75.5

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Baycare Clinic LLP Oral and Maxillofacial Surgery CurrentSince Feb 1, 2024 Accepting new patients
Group Health, Inc. CurrentSince Aug 14, 2023 Accepting new patients
Baycare Clinic LLP CurrentSince Feb 1, 2024 Accepting new patients
Group Health, Inc. Current Accepting new patients
Group Health, Inc. Oral and Maxillofacial Surgery CurrentSince Aug 14, 2023 Accepting new patients

Locations

8515 Eagle Point Blvd
Lake Elmo, MN 55042
Phone (651) 523-9950

8515 Eagle Point Blvd
#200
Lake Elmo, MN 55042
Phone (651) 523-9950

8170 33rd Ave S
Minneapolis, MN 55425
Phone (952) 883-5463

3930 Northwoods Dr
Saint Paul, MN 55112
Phone (651) 490-6775

1035 Kepler Dr
Green Bay, WI 54311

2581 Development Dr
Green Bay, WI 54311
Phone (920) 347-0400

930 Maritime Dr
Manitowoc, WI 54220
Phone (920) 682-9121

719 Doctors Ct
Oshkosh, WI 54901
Phone (920) 235-0066

636 N 12th Ave
Sturgeon Bay, WI 54235
Phone (920) 743-2001

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1518739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779148800000",
    "number": "1073013025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1035 KEPLER DR",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543118320",
            "telephone_number": "920-490-9046",
            "fax_number": "920-405-8005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2581 DEVELOPMENT DR",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543114247",
            "telephone_number": "920-347-0400",
            "fax_number": "920-347-0868"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 Hawkins Dr",
            "address_purpose": "LOCATION",
            "city": "Iowa City",
            "state": "IA",
            "postal_code": "522421009",
            "country_code": "US",
            "telephone_number": "319-356-7339",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "636 N 12th Ave",
            "address_purpose": "LOCATION",
            "city": "Sturgeon Bay",
            "state": "WI",
            "postal_code": "542351249",
            "country_code": "US",
            "telephone_number": "920-743-2001",
            "fax_number": "920-347-0868",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "930 Maritime Dr",
            "address_purpose": "LOCATION",
            "city": "Manitowoc",
            "state": "WI",
            "postal_code": "542202961",
            "country_code": "US",
            "telephone_number": "920-682-9121",
            "fax_number": "920-347-0868",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8515 Eagle Point Blvd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Lake Elmo",
            "state": "MN",
            "postal_code": "550428624",
            "country_code": "US",
            "telephone_number": "651-523-9950",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "515 Delaware St SE",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "55455",
            "country_code": "US",
            "telephone_number": "612-624-8600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PRIMLEY",
        "first_name": "KRISTA",
        "middle_name": "S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-16",
        "last_updated": "2026-05-19",
        "certification_date": "2026-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MN",
            "license": "D14292",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IA",
            "license": "RES-30533",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WI",
            "license": "6001396",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.