Individual provider Active NPI

Cody A Pangrazzi, LPSW

  • Clinical Social Worker
  • Marinette, WI
National Provider Identifier
1295259596
Registry record updated Dec 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
9204 Issued in WI
Practice address
4061 Old Peshtigo Rd
Marinette, WI 54143-3887
Phone
(715) 732-8000
NPI assigned
Jul 28, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 130736 WI
Clinical Social Worker 1041C0700X 9204 WI Primary

Addresses

Primary practice location

4061 Old Peshtigo Rd
Marinette, WI 54143-3887

Mailing address

4061 Old Peshtigo Rd
Marinette, WI 54143-3887
Phone (715) 732-8000

Other practice location 1

230 Park St
Wautoma, WI 54982-9031
Phone (920) 787-6550 ext. 636

Other identifiers 1

IdentifierTypeStateIssuer
100069692MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address cpangrazzi242690@direct.myadvocateaurora.org
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190528002229 WI Practitioner - Clinical Social Worker 9931442399 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians

Practice addresses (Care Compare)

1020 N 12TH St
Milwaukee, WI 53233-1308
Phone (414) 219-3056

1160 Kepler Dr
Green Bay, WI 54311-8321
Phone (920) 288-5500

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
130736WIMDSocial Worker
9204WIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Medical Group, Inc. CurrentSince Oct 21, 2019 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Oct 21, 2019 Accepting new patients

Locations

3003 University Dr
Marinette, WI 54143
Phone (715) 735-4200

4061 Old Peshtigo Rd
Marinette, WI 54143
Phone (715) 732-8000

1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056

3301 W Forest Home Ave
Milwaukee, WI 53215
Phone (414) 389-2233

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1501200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639353600000",
    "number": "1295259596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4061 OLD PESHTIGO RD",
            "city": "MARINETTE",
            "state": "WI",
            "postal_code": "541433887",
            "telephone_number": "715-732-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4061 OLD PESHTIGO RD",
            "city": "MARINETTE",
            "state": "WI",
            "postal_code": "541433887",
            "telephone_number": "715-732-8000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "230 Park St",
            "address_purpose": "LOCATION",
            "city": "Wautoma",
            "state": "WI",
            "postal_code": "549829031",
            "country_code": "US",
            "telephone_number": "920-787-6550 x636",
            "fax_number": "920-787-0421",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PANGRAZZI",
        "first_name": "CODY",
        "middle_name": "A",
        "credential": "LPSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-07-28",
        "last_updated": "2021-12-13",
        "certification_date": "2021-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "WI",
            "license": "130736",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "9204",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100069692",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cpangrazzi242690@direct.myadvocateaurora.org",
            "affiliation": "N",
            "address_1": "4061 Old Peshtigo Rd",
            "city": "Marinette",
            "state": "WI",
            "country_code": "US",
            "postal_code": "541433887",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "4061 Old Peshtigo Rd",
            "city": "Marinette",
            "state": "WI",
            "country_code": "US",
            "postal_code": "541433887",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Marinette, WI

Sources for this page

Verify at the official NPI Registry.