NPIMap

Organization Active NPI

Baycare Clinic LLP

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Green Bay, WI
National Provider Identifier
1174732572
Registry record updated Aug 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X
Legal business name
BAYCARE CLINIC LLP
Practice address
2581 Development Dr
Green Bay, WI 54311-4247
Phone
(920) 347-0400
Fax
(920) 347-0868
NPI assigned
May 22, 2007
Last updated
Aug 27, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
BAYCARE CLINIC LLPAs reported in NPPES

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
Durable Medical Equipment & Medical Supplies 332B00000X NU
Oral & Maxillofacial Surgery (D.M.D.) 204E00000X NU Primary

Addresses

Primary practice location

2581 Development Dr
Green Bay, WI 54311-4247

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
O20100930080025 WI DME Supplier - Multi-Specialty - Physician 4385554328 Practice locations: Green Bay, 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
52D2090130Baycare Clinic, LLP2581 Development Dr, Green Bay, WI 54311Certificate of waiverJan 14, 2027

National Provider Directory

National Provider Directory
Tax ID family
Linda Zaffke11 organizations share this tax ID, including this one
Part of
Linda Zaffke

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Locations

164 N Broadway
Green Bay, WI 54303
Phone (920) 965-4055

2581 Development Dr
Green Bay, WI 54311
Phone (920) 347-0400

NPI Registry JSON

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

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787788800000",
    "number": "1174732572",
    "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",
            "fax_number": "920-405-8005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2581 DEVELOPMENT DR",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543114247",
            "telephone_number": "920-347-0400",
            "fax_number": "920-347-0868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAYCARE CLINIC LLP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BAYCARE CLINIC LLP",
        "enumeration_date": "2007-05-22",
        "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": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, 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.