NPIMap

Organization Active NPI

Prevea Regional Services, Inc.

Doing business as Prevea Regional

  • Family Medicine Physician
  • Green Bay, WI
National Provider Identifier
1194748061
Registry record updated Sep 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PREVEA REGIONAL SERVICES, INC.
Doing business as
Prevea Regional
Practice address
2710 Executive Dr
Green Bay, WI 54304-5496
Phone
(920) 496-4700
Fax
(920) 496-4705
NPI assigned
Jul 25, 2006
Last updated
Sep 10, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2008

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

Authorized official

Name
Richard Rolston, MD
Title
President and Ceo
Phone
(920) 496-4700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

2710 Executive Dr
Green Bay, WI 54304-5496

Mailing address

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

Other names 1

  • Prevea Regional Doing business as

National Provider Directory

National Provider Directory

Locations

2710 Executive Dr
Green Bay, WI 54304
Phone (920) 272-1112

Practitioners & affiliated clinicians

Practitioners 125

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 125

NPI Registry JSON

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221004800000",
    "number": "1194748061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19070",
            "address_2": "PREVEA HEALTH REGIONAL",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543079070",
            "telephone_number": "920-496-4700",
            "fax_number": "920-496-4705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2710 EXECUTIVE DR",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543045496",
            "telephone_number": "920-496-4700",
            "fax_number": "920-496-4705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREVEA REGIONAL SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-25",
        "last_updated": "2008-09-10",
        "status": "A",
        "authorized_official_last_name": "ROLSTON",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "920-496-4700",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prevea Regional",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Sep 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.