NPIMap

Individual provider Active NPI

Tawni Nicole Kobielak, DNP

  • Family Nurse Practitioner
  • De Pere, WI
National Provider Identifier
1215466396
Registry record updated Jul 24, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
7752 Issued in WI
Practice address
3860 Monroe Rd
De Pere, WI 54115-8399
Phone
(920) 496-4700
NPI assigned
Jun 12, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 18979630 WI
Family Nurse Practitioner 363LF0000X 7752 WI Primary

Addresses

Primary practice location

3860 Monroe Rd
De Pere, WI 54115-8399

Mailing address

1807 Ridgeway Dr Unit 37
De Pere, WI 54115-4123
Phone (608) 558-9279

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170807001118 WI Practitioner - Nurse Practitioner 4981975166 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3860 Monroe Rd
De Pere, WI 54115-8399
Phone (920) 496-4700

Hospital & facility affiliations

  • St Vincent Hospital Hospital, Green Bay, WI, CCN 520075
  • St Marys Hospital Medical Ctr Hospital, Green Bay, WI, CCN 520097

Merit-based Incentive Payment System (MIPS)

Final score
94.81 of 100Reported as apm
Quality
85.98
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
18979630WIMDRegistered Nurse
7752WIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Prevea Clinic, Inc. CurrentSince Jul 17, 2017 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis CurrentSince Jul 17, 2017 Accepting new patients
St. Nicholas Hospital-Sisters of the Third Order of St Francis CurrentSince Dec 3, 2017 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis CurrentSince Jul 17, 2017 Accepting new patients
St. Nicholas Hospital-Sisters of the Third Order of St Francis Current Accepting new patients
Prevea Clinic, Inc. CurrentSince Jul 17, 2017 Accepting new patients
St Nicholas Hospital-Sisters of the Third Order of St Francis CurrentSince Dec 3, 2017 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis Past Accepting new patients

Locations

3860 Monroe Rd
De Pere, WI 54115
Phone (920) 272-1200

1726 Shawano Ave
Green Bay, WI 54303
Phone (920) 432-6016

835 S Van Buren St
Green Bay, WI 54301
Phone (888) 901-7246

950 Woodlake Rd
Kohler, WI 53044
Phone (920) 783-3150

3100 Superior Ave
Sheboygan, WI 53081
Phone (800) 472-6710

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 and National Provider Directory roles.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1497225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1500854400000",
    "number": "1215466396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1807 RIDGEWAY DR UNIT 37",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541154123",
            "telephone_number": "608-558-9279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3860 MONROE RD",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541158399",
            "telephone_number": "920-496-4700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOBIELAK",
        "first_name": "TAWNI",
        "middle_name": "NICOLE",
        "credential": "DNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-12",
        "last_updated": "2017-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WI",
            "license": "18979630",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "7752",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in De Pere, WI

Sources for this page

Verify at the official NPI Registry.