Individual provider Active NPI

Beth Ann Woods, MD

  • Pediatric Cardiology Physician
  • Green Bay, WI
National Provider Identifier
1336109123
Registry record updated Oct 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Cardiology PhysicianTaxonomy code 2080P0202X
License
62010 Issued in WI
Practice address
1821 S Webster Ave
Green Bay, WI 54301-2253
Phone
(920) 496-4700
NPI assigned
Mar 24, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2023

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 5948 AK
Pediatrics Physician 208000000X 54516 MN
Pediatric Cardiology Physician 2080P0202X 105628 MN
Pediatric Cardiology Physician 2080P0202X 62010 WI Primary

Addresses

Primary practice location

1821 S Webster Ave
Green Bay, WI 54301-2253

Mailing address

PO Box 19070
Green Bay, WI 54307-9070
Phone (920) 496-4700

Other identifiers 1

IdentifierTypeStateIssuer
MD6921MedicaidAK

Other names 1

  • Beth Ann Medford Former name

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: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140814000540 WI Practitioner - Pediatric MedicinePractitioner - Cardiovascular Disease (Cardiology) 0345249348 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5948AKMDPediatrics Physician
54516MNMDPediatrics Physician
62010WIMDPediatric Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bellin Memorial Hospital Inc Pediatrics CurrentSince Dec 1, 2019 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis Pediatrics CurrentSince Jul 14, 2014 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis CurrentSince Jul 14, 2014 Accepting new patients
Bellin Memorial Hospital Inc Current Accepting new patients
St Nicholas Hospital-Sisters of the Third Order of St Francis CurrentSince Sep 1, 2015 Accepting new patients
St Nicholas Hospital-Sisters of the Third Order of St Francis CurrentSince Sep 1, 2015 Accepting new patients
St. Nicholas Hospital-Sisters of the Third Order of St Francis Current Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis Past Accepting new patients

Locations

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

1860 Shawano Ave
Green Bay, WI 54303
Phone (920) 405-1414

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

1821 S Webster Ave
Green Bay, WI 54301
Phone (920) 431-1850

744 S Webster Ave
Green Bay, WI 54301
Phone (920) 433-6025

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

Interoperability endpoints

  • Direct secure messaging: beth.medford@avera.sdhealthlink.net
  • Direct secure messaging: bmedford50163@ewd.direct.hshs.org

Organizations & group practices 8

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": "1143158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697068800000",
    "number": "1336109123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19070",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543079070",
            "telephone_number": "920-496-4700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1821 S WEBSTER AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543012253",
            "telephone_number": "920-496-4700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOODS",
        "first_name": "BETH",
        "middle_name": "ANN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-24",
        "last_updated": "2023-10-12",
        "certification_date": "2023-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AK",
            "license": "5948",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "54516",
            "primary": false
        },
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "MN",
            "license": "105628",
            "primary": false
        },
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "WI",
            "license": "62010",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MD6921",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BETH",
            "last_name": "MEDFORD",
            "middle_name": "ANN",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.