NPIMap

Individual provider Active NPI

Jeffrey Shaha

  • Family Nurse Practitioner
  • Green Bay, WI
National Provider Identifier
1326762428
Registry record updated Jan 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
13186-33 Issued in WI
Practice address
3021 Voyager Dr
Green Bay, WI 54311-8303
Phone
(920) 496-4700
NPI assigned
Oct 3, 2022
Last updated
Jan 11, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 13186-33 WI Primary
Registered Nurse 163W00000X 154381-30 WI

Addresses

Primary practice location

3021 Voyager Dr
Green Bay, WI 54311-8303

Mailing address

3021 Voyager Dr
Green Bay, WI 54311-8303

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jshaha7162@ewd.direct.hshs.org Direct

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
I20221028001688 WI Practitioner - Nurse Practitioner 5799152088 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3021 Voyager Dr
Green Bay, WI 54311-8303
Phone (920) 496-4700

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.81 of 100Reported as apm
Quality
85.98
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
154381-30WIMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis CurrentSince Oct 1, 2022 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis CurrentSince Oct 1, 2022 Accepting new patients
St. Nicholas Hospital-Sisters of the Third Order of St Francis CurrentSince Oct 1, 2022 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis Current Accepting new patients
Prevea Clinic, Inc. CurrentSince Oct 1, 2022 Accepting new patients
St. Clare Memorial Hospital, Inc CurrentSince Dec 1, 2022 Accepting new patients
St Nicholas Hospital-Sisters of the Third Order of St Francis CurrentSince Oct 1, 2022 Accepting new patients
Prevea Clinic, Inc. CurrentSince Oct 1, 2022 Accepting new patients
St Clare Memorial Hospital, Inc CurrentSince Dec 1, 2022 Accepting new patients

Locations

1726 Shawano Ave
Green Bay, WI 54303
Phone (920) 432-6016

3021 Voyager Dr
Green Bay, WI 54311
Phone (920) 431-1810

835 S Van Buren St
Green Bay, WI 54301
Phone (888) 901-7246

855 S Main St
Oconto Falls, WI 54154
Phone (920) 846-3444

855 S Main St
Ste 1
Oconto Falls, WI 54154
Phone (920) 846-8187

3100 Superior Ave
Sheboygan, WI 53081
Phone (800) 472-6710

323 S 18th Ave
Sturgeon Bay, WI 54235
Phone (920) 743-5566

Interoperability endpoints

  • Direct secure messaging: jshaha7162@ewd.direct.hshs.org

Organizations & group practices 9

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 12

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": "1664755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673395200000",
    "number": "1326762428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3021 VOYAGER DR",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543118303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3021 VOYAGER DR",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543118303",
            "telephone_number": "920-496-4700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAHA",
        "first_name": "JEFFREY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-10-03",
        "last_updated": "2023-01-11",
        "certification_date": "2023-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "13186-33",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WI",
            "license": "154381-30",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jshaha7162@ewd.direct.hshs.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "3021 Voyager Dr",
            "city": "Green Bay",
            "state": "WI",
            "country_code": "US",
            "postal_code": "543118303",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.