Individual provider Active NPI

Timothy Richard Von Seth

  • Dermatology Physician
  • Green Bay, WI
National Provider Identifier
1356161772
Registry record updated Oct 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
8107-23 Issued in WI
Practice address
2360 Duck Creek Pkwy
Green Bay, WI 54303-3300
Phone
(920) 965-0345
NPI assigned
Oct 10, 2024
Last updated
Oct 10, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 10, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 8107-23 WI Primary

Addresses

Primary practice location

2360 Duck Creek Pkwy
Green Bay, WI 54303-3300

Mailing address

115 E Walnut St Apt 412
Green Bay, WI 54301-4212
Phone (262) 903-1940

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, MI2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20241219003237 WI Practitioner - Physician Assistant 5991232654 Reassigns benefits to 1 organization
I20250328000612 MI Practitioner - Physician Assistant 5991232654 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Philadelphia College of Osteopathic Medicine, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New Dermatology Group LTDGroup PAC ID 9537312665, 23 clinicians

Practice addresses (Care Compare)

100 County Rd B
Shawano, WI 54166-7072
Phone (920) 965-0345

1405 Mill St
New London, WI 54961-2155
Phone (920) 965-0345

1606 S Stephenson Ave
Iron Mountain, MI 49801-3636
Phone (920) 965-0345

2360 Duck Creek Pkwy
Green Bay, WI 54303-3300
Phone (920) 965-0345

2500 E Capital Dr
Appleton, WI 54911-8735
Phone (920) 569-6549

2601 1St Ave N
Escanaba, MI 49829-1448
Phone (920) 965-0345

3059 Voyager Dr
Green Bay, WI 54311-8303
Phone (920) 965-0345

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
8107-23WIMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
New Dermatology Group LTD Dermatology Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: timothy.von.seth.1@23194.direct.athenahealth.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1728518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728518400000",
    "number": "1356161772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 E WALNUT ST APT 412",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543014212",
            "telephone_number": "262-903-1940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2360 DUCK CREEK PKWY",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543033300",
            "telephone_number": "920-965-0345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VON SETH",
        "first_name": "TIMOTHY",
        "middle_name": "RICHARD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-10-10",
        "last_updated": "2024-10-10",
        "certification_date": "2024-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "WI",
            "license": "8107-23",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.