Benjamin Michael Moreau, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

7440-23 Issued in WI

Practice address

1970 S Ridge Rd
Green Bay, WI 54304-4125

Phone

(920) 430-4888

Fax

(920) 430-4889

NPI assigned

May 10, 2023

Last updated

Aug 31, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI, WI2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Physician Assistant

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bellin Memorial Hospital IncGroup PAC ID 8820900749, shared by 10 NPIs, 685 clinicians

Oconto Hospital and Medical Center IncGroup PAC ID 2163461781, 217 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Bellin Memorial Hospital Hospital, Green Bay, WI, CCN 520049

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bmoreau925673@direct.emplifyhealth.org

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.

• Oconto Hospital & Medical Center Inc

  dba Emplify Health Oconto Hospital

  • Critical Access Hospital
  • Oconto, WI
  • NPI 1356373302
  Medicare reassignment Care Compare group NPD (past)
• Bellin Memorial Hospital Inc

  dba Bellin Health Algoma

  • Rural Health Clinic/Center
  • Algoma, WI
  • NPI 1609838473
  Medicare reassignment
• Bellin Memorial Hospital Inc

  dba Bellin Health Heart & Vascular Crystal Falls

  • Cardiovascular Disease Physician
  • Crystal Falls, MI
  • NPI 1376649509
  Medicare reassignment
• Bellin Memorial Hospital Inc

  dba Bellin Health

  • Family Medicine Physician
  • Green Bay, WI
  • NPI 1033172390
  NPD
• Bellin Memorial Hospital Inc

  dba FMC Oconto Falls

  • Rural Health Clinic/Center
  • Oconto Falls, WI
  • NPI 1285696963
  NPD
• Oconto Hospital & Medical Center Inc

  dba Bellin Health Suring

  • Rural Health Clinic/Center
  • Suring, WI
  • NPI 1104418037
  NPD
• Bellin Memorial Hospital Inc

  dba FMC Iron Mountain

  • Family Medicine Physician
  • Iron Mountain, MI
  • NPI 1790045078
  NPD
• Bellin Memorial Hospital Inc

  dba FMC Brillion

  • Family Medicine Physician
  • Brillion, WI
  • NPI 1962464784
  NPD (past)

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

• Bellin Memorial Hospital Inc.

  • General Acute Care Hospital
  • Green Bay, WI
  • NPI 1891740585
  Care Compare affiliation

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

{
    "created_epoch": "1683676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693440000000",
    "number": "1215627575",
    "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": "920-445-7210",
            "fax_number": "920-445-7289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1970 S RIDGE RD",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543044125",
            "telephone_number": "920-430-4888",
            "fax_number": "920-430-4889"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "507 North 17th Street",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "53233",
            "country_code": "US",
            "telephone_number": "414-288-5688",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "440 Woodward Ave",
            "address_purpose": "LOCATION",
            "city": "Iron Mountain",
            "state": "MI",
            "postal_code": "498014631",
            "country_code": "US",
            "telephone_number": "906-776-9040",
            "fax_number": "906-774-5950",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2820 Roosevelt Rd",
            "address_purpose": "LOCATION",
            "city": "Marinette",
            "state": "WI",
            "postal_code": "541433834",
            "country_code": "US",
            "telephone_number": "715-735-5225",
            "fax_number": "715-735-5388",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "610 S Lincoln Rd",
            "address_purpose": "LOCATION",
            "city": "Escanaba",
            "state": "MI",
            "postal_code": "498291215",
            "country_code": "US",
            "telephone_number": "906-786-6488",
            "fax_number": "906-786-6409",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOREAU",
        "first_name": "BENJAMIN",
        "middle_name": "MICHAEL",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-05-10",
        "last_updated": "2023-08-31",
        "certification_date": "2023-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601011806",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "7440-23",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NAT'L COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS",
            "identifier": "1202461",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melissa Ann Mooren
• Moraine Ridge LLC
• Edward Andrew Morales, MD
• Nicki Morales, RN
• Patrick Moran, MD
• Candice Lynn Moreau
• Lizet Moreno
• Roland P Moreno, MD
• Matas Morkevicius, M.D.
• Jami M Morley, APNP

• Physician Assistant in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Physician Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.