Individual provider Active NPI

Renee R Smith, CNM,APNP

  • Advanced Practice Midwife
  • Green Bay, WI
National Provider Identifier
1174168710
Registry record updated Nov 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Advanced Practice MidwifeTaxonomy code 367A00000X
License
148970-32 Issued in WI
Practice address
720 S Vanburen St
Suite 101
Green Bay, WI 54301-3504
Phone
(920) 433-3420
Fax
(920) 338-6859
NPI assigned
Nov 7, 2019
Last updated
Nov 8, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Advanced Practice Midwife 367A00000X 148970-32 WI Primary

Addresses

Primary practice location

720 S Vanburen St
Suite 101
Green Bay, WI 54301-3504

Mailing address

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

Other practice location 1

744 S Webster Ave
Green Bay, WI 54301-3505
Phone (920) 445-7222

Other practice location 2

2641 Development Dr
Green Bay, WI 54311-4240
Phone (920) 338-6868

Other practice location 3

704 S Webster Ave
Green Bay, WI 54301-3528
Phone (920) 338-6868

Other identifiers 1

IdentifierTypeStateIssuer
CNM05317OtherAMERICAN MIDWIFERY CERTIFICATION

Other names 1

  • Renee R Dettman Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191114000224 WI Practitioner - Certified Nurse Midwife (CNM) 2466884317 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Midwife

Practice roles

OrganizationSpecialtyStatusNew patients
Bellin Memorial Hospital Inc CurrentSince Nov 11, 2019 Accepting new patients
Oconto Hospital & Medical Center Inc CurrentSince Apr 13, 2022 Accepting new patients
Oconto Hospital & Medical Center Inc Current Accepting new patients
Oconto Hospital & Medical Center Inc CurrentSince Apr 13, 2022 Accepting new patients
Bellin Memorial Hospital Inc Current Accepting new patients
Bellin Memorial Hospital Inc CurrentSince Nov 11, 2019 Accepting new patients
Bellin Memorial Hospital Inc PastSince Nov 10, 2019 Accepting new patients
Bellin Memorial Hospital Inc Past Accepting new patients

Locations

2641 Development Dr
Green Bay, WI 54311

704 S Webster Ave
Green Bay, WI 54301
Phone (920) 433-3784

720 S Van Buren St
Ste 101
Green Bay, WI 54301
Phone (920) 430-8120

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

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: rsmith280751@direct.thedacare.org
  • Direct secure messaging: rsmith924836@direct.emplifyhealth.org

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1573084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573171200000",
    "number": "1174168710",
    "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": "720 S VANBUREN ST",
            "address_2": "SUITE 101",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543013504",
            "telephone_number": "920-433-3420",
            "fax_number": "920-338-6859"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "744 S Webster Ave",
            "address_purpose": "LOCATION",
            "city": "Green Bay",
            "state": "WI",
            "postal_code": "543013505",
            "country_code": "US",
            "telephone_number": "920-445-7222",
            "fax_number": "920-445-7289",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2641 Development Dr",
            "address_purpose": "LOCATION",
            "city": "Green Bay",
            "state": "WI",
            "postal_code": "543114240",
            "country_code": "US",
            "telephone_number": "920-338-6868",
            "fax_number": "920-338-6869",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "704 S Webster Ave",
            "address_purpose": "LOCATION",
            "city": "Green Bay",
            "state": "WI",
            "postal_code": "543013528",
            "country_code": "US",
            "telephone_number": "920-338-6868",
            "fax_number": "920-338-6869",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "RENEE",
        "middle_name": "R",
        "credential": "CNM,APNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-07",
        "last_updated": "2019-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "WI",
            "license": "148970-32",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICAN MIDWIFERY CERTIFICATION",
            "identifier": "CNM05317",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RENEE",
            "last_name": "DETTMAN",
            "middle_name": "R",
            "credential": "CNM., APNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.