NPIMap

Organization Active NPI

Bellin Memorial Hospital Inc

Doing business as Bellin Health Fast Care West

  • Family Medicine Physician
  • Green Bay, WI
National Provider Identifier
1073566725
Registry record updated Oct 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
BELLIN MEMORIAL HOSPITAL INC
Doing business as
Bellin Health Fast Care West
FMC Bellin Health Fast Care Ashwaubenon
Practice address
2015 Shawano Ave
Green Bay, WI 54303-2606
Phone
(920) 592-9478
Fax
(920) 592-9479
NPI assigned
May 17, 2006
Last updated
Oct 18, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2021

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

Authorized official

Name
Denise K Stroobants
Title
Credentialing Specialist
Phone
(920) 433-7864

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

2015 Shawano Ave
Green Bay, WI 54303-2606

Mailing address

PO Box 22487
Green Bay, WI 54305-2487
Phone (920) 445-7222

Other names 2

  • Bellin Health Fast Care West Doing business as
  • FMC BELLIN HEALTH FAST CARE ASHWAUBENON Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031121000089 WI Part B Supplier - Clinic/Group Practice 8820900749 Receives reassigned benefits from 936 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634515200000",
    "number": "1073566725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22487",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543052487",
            "telephone_number": "920-445-7222",
            "fax_number": "920-445-7289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2015 SHAWANO AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543032606",
            "telephone_number": "920-592-9478",
            "fax_number": "920-592-9479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BELLIN MEMORIAL HOSPITAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-17",
        "last_updated": "2021-10-18",
        "certification_date": "2021-10-18",
        "status": "A",
        "authorized_official_last_name": "STROOBANTS",
        "authorized_official_first_name": "DENISE",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "920-433-7864"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bellin Health Fast Care West",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "FMC BELLIN HEALTH FAST CARE ASHWAUBENON",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "FMC BELLIN HEALTH FAST CARE ASHWAUBENON",
            "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 Oct 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.