Active NPI
Prevea Clinic, Inc.
- Internal Medicine Physician
- Green Bay, WI
National Provider Identifier
1306869276
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- Legal business name
- PREVEA CLINIC, INC.
- Practice address
- 2710 Executive Dr
Green Bay, WI 54304-5496 - Phone
- (920) 496-4700
- Fax
- (920) 496-4705
- NPI assigned
- Jul 25, 2006
- Last updated
- Jan 12, 2022
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ashok N Rai, MD
- Title
- President/Ceo
- Phone
- (920) 496-4700
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 15
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Allergy & Immunology Physician | 207K00000X | NU | ||
| Family Medicine Physician | 207Q00000X | NU | ||
| Internal Medicine Physician | 207R00000X | NU | Primary | |
| Cardiovascular Disease Physician | 207RC0000X | NU | ||
| Gastroenterology Physician | 207RG0100X | NU | ||
| Infectious Disease Physician | 207RI0200X | NU | ||
| Pulmonary Disease Physician | 207RP1001X | NU | ||
| Obstetrics & Gynecology Physician | 207V00000X | NU | ||
| Gynecologic Oncology Physician | 207VX0201X | NU | ||
| Ophthalmology Physician | 207W00000X | NU | ||
| Orthopaedic Surgery Physician | 207X00000X | NU | ||
| Otolaryngology Physician | 207Y00000X | NU | ||
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | NU | ||
| Pediatrics Physician | 208000000X | NU | ||
| Pediatric Allergy/Immunology Physician | 2080P0201X | NU |
Addresses
Primary practice location
2710 Executive Dr
Green Bay, WI 54304-5496
Mailing address
PO Box 19070
Prevea Health
Green Bay, WI 54307-9070
Phone (920) 496-4700
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 32704600 | Medicaid | WI |
Other names 1
- Prevea Health
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031106000034 | WI | Part B Supplier - Clinic/Group Practice | 0042123150 |
Receives reassigned benefits from 229 practitioners 1 other NPI on this enrollment Practice locations: Oconto Falls, WI; Oconto, WI; Marinette, WI; Manitowoc, WI; Luxemburg, WI; Kohler, WI; Kewaunee, WI; Oneida, WI… |
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryLocations
1727 Shawano Ave
Ste 201
Green Bay, WI 54303
Phone (920) 496-8877
1409 Cleveland Ave
Marinette, WI 54143
Phone (715) 732-0832
620 Smith Ave
Oconto, WI 54153
Phone (920) 834-4110
Practitioners & affiliated clinicians
Practitioners 374
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
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- Obstetrics & Gynecology Physician
- Sheboygan, WI
- NPI 1740626639
-
- Family Medicine Physician
- Sheboygan, WI
- NPI 1932712593
-
- Family Nurse Practitioner
- Green Bay, WI
- NPI 1316222771
-
- Advanced Practice Midwife
- Green Bay, WI
- NPI 1225448681
-
- Hospitalist Physician
- Green Bay, WI
- NPI 1447276985
-
- Surgery Physician
- Green Bay, WI
- NPI 1174934806
-
- Family Nurse Practitioner
- Sheboygan, WI
- NPI 1285517946
-
- Family Medicine Physician
- Green Bay, WI
- NPI 1477559938
-
- Obstetrics & Gynecology Physician
- Green Bay, WI
- NPI 1467658302
-
- Nurse Practitioner
- Green Bay, WI
- NPI 1114526530
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153785600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1641945600000",
"number": "1306869276",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 19070",
"address_2": "PREVEA HEALTH",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543079070",
"telephone_number": "920-496-4700",
"fax_number": "920-496-4705"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2710 EXECUTIVE DR",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543045496",
"telephone_number": "920-496-4700",
"fax_number": "920-496-4705"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PREVEA CLINIC, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2006-07-25",
"last_updated": "2022-01-12",
"certification_date": "2022-01-12",
"status": "A",
"authorized_official_last_name": "RAI",
"authorized_official_first_name": "ASHOK",
"authorized_official_middle_name": "N",
"authorized_official_title_or_position": "PRESIDENT/CEO",
"authorized_official_telephone_number": "920-496-4700",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207K00000X",
"taxonomy_group": "",
"desc": "Allergy & Immunology",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "NU",
"license": null,
"primary": true
},
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "207RG0100X",
"taxonomy_group": "",
"desc": "Internal Medicine, Gastroenterology",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "207RI0200X",
"taxonomy_group": "",
"desc": "Internal Medicine, Infectious Disease",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "207RP1001X",
"taxonomy_group": "",
"desc": "Internal Medicine, Pulmonary Disease",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "207VX0201X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology, Gynecologic Oncology",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "207X00000X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "2080P0201X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Allergy/Immunology",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "32704600",
"state": "WI"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Prevea Health",
"code": "5",
"type": "Other Name"
},
{
"organization_name": "Prevea Health",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Green Bay, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.