Active NPI
Robert Alan Cavanaugh, MD
- Obstetrics & Gynecology Physician
- De Pere, WI
National Provider Identifier
1295814176
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- 25135
- Practice address
- 1800 Lawrence Dr
De Pere, WI 54115-9108 - Phone
- (920) 983-3220
- NPI assigned
- Nov 3, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 25135 | WI | Primary |
Addresses
Primary practice location
1800 Lawrence Dr
De Pere, WI 54115-9108
Mailing address
PO Box 22487
Green Bay, WI 54305-2487
Phone (920) 445-7222
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30522900 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25135 | WI | MD | Obstetrics & Gynecology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bellin Memorial Hospital Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162512000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1449014400000",
"number": "1295814176",
"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": "920-445-7222",
"fax_number": "920-445-7289"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1800 LAWRENCE DR",
"city": "DE PERE",
"state": "WI",
"postal_code": "541159108",
"telephone_number": "920-983-3220"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CAVANAUGH",
"first_name": "ROBERT",
"middle_name": "ALAN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-03",
"last_updated": "2015-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "WI",
"license": "25135",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30522900",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in De Pere, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.