Colleen M Van Egeren, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2178-023 Issued in WI

Practice address

715 Superior Rd
Suite 120
Green Bay, WI 54311-7594

Phone

(920) 406-9803

NPI assigned

Sep 20, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Ms. Colleen M Nelson Former name

Medicare fee-for-service enrollment

Enrolled in WI

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 1

Specialty

Physician Assistant

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wisconsin Institute of Plastic Surgery SCGroup PAC ID 3678574662, 4 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Door County Medical Center Hospital, Sturgeon Bay, WI, CCN 521358

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Wisconsin Institute of Plastic Surgery SC

  • Plastic Surgery Physician
  • Appleton, WI
  • NPI 1487703880
  Medicare reassignment Care Compare group
• Fox Valley Urological Associates SC

  • Urology Physician
  • Appleton, WI
  • NPI 1356601587
  NPD (past)
• New Dermatology Group LTD

  • Dermatology Physician
  • Iron Mountain, MI
  • NPI 1710321633
  NPD (past)

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

• Door County Memorial Hospital

  • Critical Access Hospital
  • Sturgeon Bay, WI
  • NPI 1093743874
  Care Compare affiliation
• Door County Memorial Hospital

  • Clinical Medical Laboratory
  • Sturgeon Bay, WI
  • NPI 1811090285

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1190246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1265628507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 E ENTERPRISE AVE",
            "address_2": "STE A",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549137656",
            "telephone_number": "920-406-9803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 SUPERIOR RD",
            "address_2": "SUITE 120",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543117594",
            "telephone_number": "920-406-9803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN EGEREN",
        "first_name": "COLLEEN",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-20",
        "last_updated": "2023-03-07",
        "certification_date": "2021-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "2178-023",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "COLLEEN",
            "last_name": "NELSON",
            "middle_name": "M",
            "prefix": "MS.",
            "credential": "P.A.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ashlee Jo Van de Wettering
• Tracy Lynn Van de Yacht, PTA
• William Leonard Van Dorp, MD
• Erica Lynn Van Dyke, RDN
• Kirsten Rose Van Dyke, MS, TIC-C
• Josephine Maryetta Van Ess, DDS
• Nicholas Van Ess, DDS
• Amy Van Gheem, MD
• Phoenix Van Laanen, LCSW
• Vanessa Van Lanen

• 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 Mar 7, 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.