NPIMap

Individual provider Active NPI

Philip Thomas Skummer

  • Vascular & Interventional Radiology Physician
  • Green Bay, WI
National Provider Identifier
1104386911
Registry record updated Aug 25, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
License
76025-20 Issued in WI
Practice address
744 S Webster Ave
Green Bay, WI 54301-3505
Phone
(920) 433-6084
NPI assigned
Mar 20, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular & Interventional Radiology Physician 2085R0204X 76025-20 WI Primary

Addresses

Primary practice location

744 S Webster Ave
Green Bay, WI 54301-3505

Mailing address

744 S Webster Ave
Green Bay, WI 54301-3505
Phone (920) 433-3500

Other practice location 1

2845 Greenbrier Rd
Green Bay, WI 54311-6519
Phone (920) 288-8000

Other identifiers 1

IdentifierTypeStateIssuer
100180781MedicaidWI

Electronic endpoints 3

TypeEndpointUseAffiliation
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/
Direct Messaging Address pskummer455712@direct.myadvocateaurora.org Direct
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, MI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20250811001835 WI Practitioner - Interventional RadiologyPractitioner - Diagnostic Radiology 1557797081 Reassigns benefits to 3 organizations
I20260120002751 MI Practitioner - Interventional Radiology 1557797081 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Interventional Radiology
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Francis HospitalGroup PAC ID 5991604753, 85 clinicians
Bellin Memorial Hospital IncGroup PAC ID 8820900749, 685 clinicians
Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians
Oconto Hospital and Medical Center IncGroup PAC ID 2163461781, 217 clinicians

Practice addresses (Care Compare)

3409 Ludington St
Suite 206
Escanaba, MI 49829-4213
Phone (906) 233-4250

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

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

Hospital & facility affiliations

  • Bellin Memorial Hospital Hospital, Green Bay, WI, CCN 520049
  • Osf St Francis Hospital and Medical Group Hospital, Escanaba, MI, CCN 231337
  • Bellin Health Oconto Hospital Hospital, Oconto, WI, CCN 521356
  • Marshfield Medical Center Hospital, Iron Mountain, MI, CCN 231342

Procedures performed for Medicare patients

ProcedureNumber of procedures
Leg revascularization (restoring blood flow)1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Oconto Hospital & Medical Center Inc CurrentSince Jul 9, 2025 Accepting new patients
Oconto Hospital & Medical Center Inc CurrentSince Jul 9, 2025 Accepting new patients
Bellin Memorial Hospital Inc Current Accepting new patients
St. Francis Hospital CurrentSince Nov 23, 2025 Accepting new patients
Bellin Memorial Hospital Inc CurrentSince Jul 9, 2025 Accepting new patients
Oconto Hospital & Medical Center Inc Current Accepting new patients
Osf Multi-Specialty Group CurrentSince Dec 26, 2025 Accepting new patients
Bellin Memorial Hospital Inc CurrentSince Jul 9, 2025 Accepting new patients
St Francis Hospital CurrentSince Nov 23, 2025 Accepting new patients
Bellin Memorial Hospital Inc PastSince Dec 26, 2025 Accepting new patients

Locations

3409 Ludington St
Ste 104
Escanaba, MI 49829
Phone (906) 786-8343

3409 Ludington St
Ste 206
Escanaba, MI 49829
Phone (906) 786-7471

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

2845 Greenbrier Rd
Green Bay, WI 54311
Phone (920) 288-3388

744 S Webster Ave
#2
Green Bay, WI 54301

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

Organizations & group practices 35

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.

View all 35

Hospital & facility affiliations 4

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": "1553040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787616000000",
    "number": "1104386911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "744 S WEBSTER AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543013505",
            "telephone_number": "920-433-3500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "744 S WEBSTER AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543013505",
            "telephone_number": "920-433-6084"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2845 Greenbrier Rd",
            "address_purpose": "LOCATION",
            "city": "Green Bay",
            "state": "WI",
            "postal_code": "543116519",
            "country_code": "US",
            "telephone_number": "920-288-8000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SKUMMER",
        "first_name": "PHILIP",
        "middle_name": "THOMAS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-20",
        "last_updated": "2026-08-25",
        "certification_date": "2026-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "WI",
            "license": "76025-20",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100180781",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "2845 Greenbrier Rd",
            "city": "Green Bay",
            "state": "WI",
            "country_code": "US",
            "postal_code": "543116519",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pskummer455712@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2845 Greenbrier Rd",
            "city": "Green Bay",
            "state": "WI",
            "country_code": "US",
            "postal_code": "543116519",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "N",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "64 S PRICE RD STE B",
            "city": "BROWNSVILLE",
            "state": "TX",
            "country_code": "US",
            "postal_code": "785212459",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.