NPIMap

Individual provider Active NPI

Logan Robert Gorges, M.D.

  • Emergency Medicine Physician
  • Waupaca, WI
National Provider Identifier
1295146223
Registry record updated Apr 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
74348 Issued in WI
Practice address
800 Riverside Dr
Waupaca, WI 54981-1943
Phone
(715) 258-1000
Fax
(715) 258-1042
NPI assigned
May 13, 2014
Last updated
Apr 29, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 0101260237 VA
Emergency Medicine Physician 207P00000X 74348 WI Primary

Addresses

Primary practice location

800 Riverside Dr
Waupaca, WI 54981-1943

Mailing address

3 Neenah Ctr
Neenah, WI 54956-3070
Phone (920) 454-4229

Other practice location 1

814 Marshall Dr
Fort Riley, KS 66442
Phone (852) 396-6457

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
I20210506002916 WI Practitioner - Emergency Medicine 2163851486 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Wisconsin School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fox Valley Emergency Medicine S CGroup PAC ID 1052324753, 11 clinicians

Practice addresses (Care Compare)

130 2ND St
Neenah, WI 54956-2883
Phone (920) 729-3100

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
0101260237VAMDEmergency Medicine Physician
74348WIMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Thedacare Medical Center - Berlin, Inc. CurrentSince Apr 6, 2024 Accepting new patients
Thedacare Medical Center - Wild Rose, Inc CurrentSince Apr 6, 2024 Accepting new patients
Thedacare Medical Center - Shawano, Inc. CurrentSince Apr 6, 2024 Accepting new patients
Thedacare Medical Center - New London, Inc. CurrentSince Apr 6, 2024 Accepting new patients
Thedacare Medical Center - Shawano, Inc. CurrentSince Apr 6, 2024 Accepting new patients
Thedacare Medical Center - Waupaca, Inc. CurrentSince May 15, 2021 Accepting new patients
Thedacare Medical Center - New London, Inc CurrentSince Apr 6, 2024 Accepting new patients
Thedacare Medical Center - Berlin, Inc. CurrentSince Apr 6, 2024 Accepting new patients
Thedacare Medical Center - Waupaca, Inc. Emergency Medicine CurrentSince May 15, 2021 Accepting new patients
Fox Valley Emergency Medicine S.C. Emergency Medicine CurrentSince Apr 1, 2025 Accepting new patients
Richard S Veiga MD SC Current Accepting new patients

Locations

225 Memorial Dr
Berlin, WI 54923
Phone (920) 361-1313

130 2nd St
Neenah, WI 54956
Phone (920) 729-2063

3 Neenah Ctr
Neenah, WI 54956
Phone (920) 454-4229

1405 Mill St
New London, WI 54961
Phone (920) 531-2000

100 Cty Road B
Shawano, WI 54166
Phone (715) 524-2161

800 Riverside Dr
Waupaca, WI 54981
Phone (715) 258-1000

601 Grove Ave
Wild Rose, WI 54984
Phone (920) 622-3257

Interoperability endpoints

  • Direct secure messaging: lgorges68014@direct.thedacare.org

Organizations & group practices 11

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.

Hospital & facility affiliations 5

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": "1399939200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619654400000",
    "number": "1295146223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 NEENAH CTR",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549563070",
            "telephone_number": "920-454-4229",
            "fax_number": "920-993-5001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 RIVERSIDE DR",
            "city": "WAUPACA",
            "state": "WI",
            "postal_code": "549811943",
            "telephone_number": "715-258-1000",
            "fax_number": "715-258-1042"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "814 Marshall Dr",
            "address_purpose": "LOCATION",
            "city": "Fort Riley",
            "state": "KS",
            "postal_code": "66442",
            "country_code": "US",
            "telephone_number": "852-396-6457",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GORGES",
        "first_name": "LOGAN",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-05-13",
        "last_updated": "2021-04-29",
        "certification_date": "2021-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "VA",
            "license": "0101260237",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WI",
            "license": "74348",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waupaca, WI

Sources for this page

Verify at the official NPI Registry.