NPIMap

Organization Active NPI

St Vincent Hospital-Hospital Sisters-Third Order of St Francis

Doing business as Prevea Health ENT

  • Otolaryngology Physician
  • Shawano, WI
National Provider Identifier
1194314013
Registry record updated Aug 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
ST VINCENT HOSPITAL-HOSPITAL SISTERS-THIRD ORDER OF ST FRANCIS
Doing business as
Prevea Health ENT
Practice address
100 County Road B
Shawano, WI 54166-7072
Phone
(920) 496-4700
NPI assigned
Jan 14, 2021
Last updated
Aug 24, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
ST VINCENT HOSPITAL-HOSPITAL SISTERS-THIRD ORDER OF ST FRANCISAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 24, 2022

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

Authorized official

Name
Patty Allen
Title
Cfo
Phone
(920) 496-4700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X NU Primary

Addresses

Primary practice location

100 County Road B
Shawano, WI 54166-7072

Mailing address

PO Box 19070
Green Bay, WI 54307-9070
Phone (920) 496-4700

Other names 1

  • Prevea Health ENT Doing business as

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address prevea_transitions_of_care2201213@ewd.direct.hshs.org Direct
Direct Messaging Address prevea_transitions_of_care2201213@ewd.direct.hshs.org Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080620000423 WI Part B Supplier - Clinic/Group Practice 5799694675 Receives reassigned benefits from 784 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Green Bay, WI; Kewaunee, WI; Luxemburg, WI; Manitowoc, WI; Marinette, WI; Oconto, WI; Oconto Falls, WI; Pulaski, WI…

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
St Vincent Hospital Physici

Locations

3750 Investors Ct
Grand Chute, WI 54913

1727 Shawano Ave
Green Bay, WI 54303
Phone (920) 431-1810

2461 Holmgren Way
Green Bay, WI 54304
Phone (920) 272-3326

670 Cormier Rd
Green Bay, WI 54304
Phone (920) 494-9685

1020 Marquette Dr
Kewaunee, WI 54216
Phone (920) 388-0144

Practitioners & affiliated clinicians

Practitioners 222

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 222

NPI Registry JSON

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

{
    "created_epoch": "1610582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661299200000",
    "number": "1194314013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19070",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543079070",
            "telephone_number": "920-496-4700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 COUNTY ROAD B",
            "city": "SHAWANO",
            "state": "WI",
            "postal_code": "541667072",
            "telephone_number": "920-496-4700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST VINCENT HOSPITAL-HOSPITAL SISTERS-THIRD ORDER OF ST FRANCIS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST VINCENT HOSPITAL-HOSPITAL SISTERS-THIRD ORDER OF ST FRANCIS",
        "enumeration_date": "2021-01-14",
        "last_updated": "2022-08-24",
        "certification_date": "2022-08-24",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "PATTY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "920-496-4700"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "prevea_transitions_of_care2201213@ewd.direct.hshs.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "cda/ccd/txt",
            "address_1": "1300 E Green Bay St",
            "city": "Shawano",
            "state": "WI",
            "country_code": "US",
            "postal_code": "541662210",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "prevea_transitions_of_care2201213@ewd.direct.hshs.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "100 County Road B",
            "city": "Shawano",
            "state": "WI",
            "country_code": "US",
            "postal_code": "541667072",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Prevea Health ENT",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Prevea Health ENT",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shawano, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.