Individual provider Active NPI

Chad T Meyer, OT

  • Occupational Therapist
  • Marinette, WI
National Provider Identifier
1104367200
Registry record updated Apr 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
6012-26 Issued in WI
Practice address
2820 Roosevelt Rd
Marinette, WI 54143-3834
Phone
(715) 735-5225
Fax
(715) 735-5388
NPI assigned
Mar 9, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 6012-26 WI Primary

Addresses

Primary practice location

2820 Roosevelt Rd
Marinette, WI 54143-3834

Mailing address

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

Other practice location 1

1630 Commanche Ave
Green Bay, WI 54313-5753
Phone (920) 430-4700

Other practice location 2

3263 Eaton Rd
Green Bay, WI 54311-6830
Phone (920) 433-6700

Other identifiers 1

IdentifierTypeStateIssuer
6012-26OtherWIWISCONSIN LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170314000415 WI Practitioner - Occupational Therapist in Private Practice 1355626375 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bellin Memorial Hospital IncGroup PAC ID 8820900749, 685 clinicians
Oconto Hospital and Medical Center IncGroup PAC ID 2163461781, 217 clinicians

Practice addresses (Care Compare)

744 S Webster Ave
Green Bay, WI 54301-3505
Phone (920) 433-6025

820 Arbutus Ave
Oconto, WI 54153-2004
Phone (920) 835-1100

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6012-26WIMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Bellin Memorial Hospital Inc Occupational Therapist CurrentSince Feb 9, 2017 Accepting new patients
Oconto Hospital & Medical Center, Inc. CurrentSince Mar 8, 2017 Accepting new patients
Bellin Memorial Hospital Inc CurrentSince Feb 9, 2017 Accepting new patients
Bellin Memorial Hospital Inc Current Accepting new patients
Oconto Hospital & Medical Center Inc Current Accepting new patients
Oconto Hospital & Medical Center Inc CurrentSince Mar 8, 2017 Accepting new patients

Locations

2305 San Luis Pl
Green Bay, WI 54304
Phone (920) 494-2817

744 S Webster Ave
Green Bay, WI 54301
Phone (920) 433-6025

1630 Commanche Ave
Green Bay, WI 54313
Phone (920) 430-4700

3263 Eaton Rd
Green Bay, WI 54311
Phone (920) 433-6000

2820 Roosevelt Rd
Marinette, WI 54143
Phone (715) 330-6171

820 Arbutus Ave
Oconto, WI 54153
Phone (920) 835-1100

Interoperability endpoints

  • Direct secure messaging: cmeyer177369@direct.thedacare.org

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1489017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651104000000",
    "number": "1104367200",
    "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": "2820 ROOSEVELT RD",
            "city": "MARINETTE",
            "state": "WI",
            "postal_code": "541433834",
            "telephone_number": "715-735-5225",
            "fax_number": "715-735-5388"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1630 Commanche Ave",
            "address_purpose": "LOCATION",
            "city": "Green Bay",
            "state": "WI",
            "postal_code": "543135753",
            "country_code": "US",
            "telephone_number": "920-430-4700",
            "fax_number": "920-430-4747",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3263 Eaton Rd",
            "address_purpose": "LOCATION",
            "city": "Green Bay",
            "state": "WI",
            "postal_code": "543116830",
            "country_code": "US",
            "telephone_number": "920-433-6700",
            "fax_number": "920-433-6719",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MEYER",
        "first_name": "CHAD",
        "middle_name": "T",
        "credential": "OT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-09",
        "last_updated": "2022-04-28",
        "certification_date": "2022-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "WI",
            "license": "6012-26",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WISCONSIN LICENSE",
            "identifier": "6012-26",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marinette, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.