NPIMap

Individual provider Active NPI

Alexa Mary Clare Gavaga

  • Internal Medicine Physician
  • Oconto Falls, WI
National Provider Identifier
1093166266
Registry record updated Aug 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
70162-20 Issued in WI
Practice address
835 S Main St Ste 1
Oconto Falls, WI 54154-1282
Phone
(920) 855-2823
NPI assigned
Jun 28, 2016
Last updated
Aug 30, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X 70162-20 WI Primary

Addresses

Primary practice location

835 S Main St Ste 1
Oconto Falls, WI 54154-1282

Mailing address

835 S Main St
Ste 1
Oconto Falls, WI 54154-1282
Phone (201) 515-7883

Other practice location 1

355 Grand St
Jersey City, NJ 07302-4321
Phone (201) 915-2431

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190911000663 WI Practitioner - Internal Medicine 4789913112 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1300 E Green Bay St
Shawano, WI 54166-2210
Phone (920) 496-4700

1409 Cleveland Ave
Marinette, WI 54143-3918
Phone (920) 496-4700

1686 Eisenhower Rd
De Pere, WI 54115-8145
Phone (920) 496-4700

1821 S Webster Ave
Green Bay, WI 54301-2253
Phone (920) 496-4700

1860 Shawano Ave
Green Bay, WI 54303-2667
Phone (920) 496-4700

2502 S Ashland Ave
Green Bay, WI 54304-5252
Phone (920) 496-4700

2793 Lineville Rd
Green Bay, WI 54313-7152
Phone (920) 496-4700

3021 Voyager Dr
Green Bay, WI 54311-8303
Phone (920) 496-4700

3750 Investors CT
Grand Chute, WI 54913-2330
Phone (920) 496-4700

3860 Monroe Rd
De Pere, WI 54115-8399
Phone (920) 496-4700

835 S Van Buren St
Green Bay, WI 54301-3526
Phone (920) 496-4700

940 S Saint Augustine St
Pulaski, WI 54162-9453
Phone (920) 496-4700

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.81 of 100Reported as apm
Quality
85.98
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis CurrentSince Sep 1, 2019 Accepting new patients
St. Nicholas Hospital-Sisters of the Third Order of St Francis Internal Medicine Current Accepting new patients
St Nicholas Hospital-Sisters of the Third Order of St Francis CurrentSince Sep 1, 2019 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis Internal Medicine CurrentSince Sep 1, 2019 Accepting new patients
St Nicholas Hospital-Sisters of the Third Order of St Francis Internal Medicine CurrentSince Sep 1, 2019 Accepting new patients
St Clare Memorial Hospital, Inc CurrentSince Sep 1, 2019 Accepting new patients

Locations

835 S Van Buren St
Green Bay, WI 54301
Phone (888) 901-7246

2793 Lineville Rd
Howard, WI 54313

835 S Main St
Ste 1
Oconto Falls, WI 54154
Phone (920) 846-4864

855 S Main St
Ste 1
Oconto Falls, WI 54154
Phone (920) 846-8187

3100 Superior Ave
Sheboygan, WI 53081
Phone (800) 472-6710

Organizations & group practices 6

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.

Hospital & facility affiliations 11

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": "1467072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567123200000",
    "number": "1093166266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "835 S MAIN ST",
            "address_2": "STE 1",
            "city": "OCONTO FALLS",
            "state": "WI",
            "postal_code": "541541282",
            "telephone_number": "201-515-7883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "835 S MAIN ST STE 1",
            "city": "OCONTO FALLS",
            "state": "WI",
            "postal_code": "541541282",
            "telephone_number": "920-855-2823"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "355 Grand St",
            "address_purpose": "LOCATION",
            "city": "Jersey City",
            "state": "NJ",
            "postal_code": "073024321",
            "country_code": "US",
            "telephone_number": "201-915-2431",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GAVAGA",
        "first_name": "ALEXA",
        "middle_name": "MARY CLARE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-28",
        "last_updated": "2019-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "70162-20",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oconto Falls, WI

Sources for this page

Verify at the official NPI Registry.