Bellin Memorial Hospital Inc
Organization Active NPI Family Medicine Physician · Green Bay, WI
NPI 1104022128 · NPPES record last updated Apr 6, 2022
Key facts
- NPI
- 1104022128
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- BELLIN MEMORIAL HOSPITAL INC
- Practice address
- 704 S Webster Ave Ste 201
Green Bay, WI 54301-3528 - Phone
- (920) 433-3410
- Fax
- (920) 433-3419
- NPI assigned
- Jun 26, 2007
- Organization subpart
- No
Authorized official
- Name
- Denise K Stroobants
- Title
- Credentialing Specialist
- Phone
- (920) 445-7222
Corporate family (same tax ID) 16
Practitioners 28
-
Hannah Lea Alsteen, FNP-C
-
Antonino Bommarito, PA-C
-
Ernesto Brauer, MD
-
Hilary Anne Hetzel, APNP
-
Kim L Lasecki, PHD
-
Tara M Lien, NP
-
Kristian V Lozev, M.D.
-
Megumi Meldrum, FNP
-
Vijaya K Munagala, M.D.
-
David A Rader, PT
-
Ashley M Stueber, OT
-
Emily Ann Wickert, SLP
-
Martha L Wilson, PT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
- Tax ID family
- Daggett Medical Clinic
Locations
704 S Webster Ave
#201
Green Bay, WI 54301
Phone (920) 433-3410
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
704 S Webster Ave Ste 201
Green Bay, WI 54301-3528
Mailing address
PO Box 22487
Green Bay, WI 54305-2487
Phone (920) 445-7222
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 21312700 | Medicaid | WI |
Other names
- DBA CLINICA HISPANA
Other providers in Green Bay, WI
- Bellin Memorial Hospital
- Bellin Memorial Hospital Inc
- Bellin Memorial Hospital Inc
- Bellin Memorial Hospital Inc
- Bellin Memorial Hospital Inc
- Bellin Memorial Hospital Inc
- Bellin Memorial Hospital Inc
- Bellin Memorial Hospital Inc
- Bellin Memorial Hospital Inc
- Bellin Memorial Hospital Inc
All providers in Green Bay, WI · Family Medicine Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 6, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.