Organization Active NPI

Baycare Clinic LLP

  • Durable Medical Equipment & Medical Supplies
  • Manitowoc, WI
National Provider Identifier
1134490758
Registry record updated Aug 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
BAYCARE CLINIC LLP
Practice address
930 Maritime Dr
Manitowoc, WI 54220-2961
Phone
(920) 682-9121
Fax
(920) 682-7188
NPI assigned
Jan 13, 2012
Last updated
Aug 27, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2026

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

Authorized official

Name
Taylor Konkle
Title
Payor Enrollment
Phone
(920) 301-1327

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193200000X MULTI-SPECIALTY GROUP 1223S0112X
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

930 Maritime Dr
Manitowoc, WI 54220-2961

Mailing address

PO Box 28900
Green Bay, WI 54324-0900
Phone (920) 490-9046

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241221000043 WI DME Supplier - Physician - Maxillofacial Surgery 4385554328 Practice locations: Manitowoc, WI

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
52D2090134Baycare Clinic, LLP930 Maritime Dr, Manitowoc, WI 54220Certificate of waiverJan 14, 2027

National Provider Directory

National Provider Directory

Locations

1711 S Stephenson Ave
Ste 230
Iron Mountain, MI 49801
Phone (877) 229-2273

4648 W Spencer St
Appleton, WI 54914
Phone (920) 731-7557

2253 W Mason St
#100
Green Bay, WI 54303
Phone (920) 327-7000

2253 W Mason St
Ste 100
Green Bay, WI 54303
Phone (920) 327-7000

2605 Development Dr
Green Bay, WI 54311
Phone (920) 288-8240

2845 Greenbrier Rd
Fl 2
Green Bay, WI 54311
Phone (920) 288-4700

2845 Greenbrier Rd
Ste 220
Green Bay, WI 54311
Phone (920) 288-8230

1500 Arbor Way
Ste 300
Kaukauna, WI 54130
Phone (920) 327-7200

1111 Bayshore Dr
Manitowoc, WI 54220
Phone (920) 682-6376

930 Maritime Dr
Manitowoc, WI 54220
Phone (920) 682-9121

1400 University Dr
Marinette, WI 54143
Phone (715) 732-4181

3003 University Dr
Ste 304
Marinette, WI 54143
Phone (715) 732-8200

3117 Shore Dr
#102
Marinette, WI 54143
Phone (715) 732-8200

3130 Shore Dr
Ste 109
Marinette, WI 54143
Phone (715) 735-9494

10624 N Port Washington Rd
Mequon, WI 53092
Phone (920) 497-0003

1136 Westowne Dr
Neenah, WI 54956
Phone (920) 456-2030

480 N Koeller St
Oshkosh, WI 54902
Phone (920) 233-8739

630 Riverfront Dr
Sheboygan, WI 53081
Phone (920) 682-6376

242 Michigan St
Ste 301
Sturgeon Bay, WI 54235
Phone (866) 726-8200

30 N 18th Ave
Ste 6
Sturgeon Bay, WI 54235
Phone (920) 743-2001

636 N 12th Ave
Sturgeon Bay, WI 54235
Phone (920) 743-2001

5300 Memorial Dr
Ste 303
Two Rivers, WI 54241
Phone (920) 793-6550

Practitioners & affiliated clinicians

Practitioners 365

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 365

NPI Registry JSON

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

{
    "created_epoch": "1326412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787788800000",
    "number": "1134490758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 28900",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543240900",
            "telephone_number": "920-490-9046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 MARITIME DR",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542202961",
            "telephone_number": "920-682-9121",
            "fax_number": "920-682-7188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAYCARE CLINIC LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-13",
        "last_updated": "2026-08-27",
        "certification_date": "2026-08-27",
        "status": "A",
        "authorized_official_last_name": "KONKLE",
        "authorized_official_first_name": "TAYLOR",
        "authorized_official_title_or_position": "PAYOR ENROLLMENT",
        "authorized_official_telephone_number": "920-301-1327"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manitowoc, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2026; 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.