Individual provider Active NPI

Charles Leroy Frederick Schultz, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Manitowoc, WI
National Provider Identifier
1356880868
Registry record updated Jan 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
76987-20 Issued in WI
Practice address
801 York St
Manitowoc, WI 54220-4630
Phone
(920) 683-5278
Fax
(920) 686-9674
NPI assigned
Feb 16, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatopathology Physician 207ND0900X 76987-20 WI
Dermatopathology (Pathology) Physician 207ZD0900X 76987-20 WI
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 76987-20 WI Primary

Addresses

Primary practice location

801 York St
Manitowoc, WI 54220-4630

Mailing address

801 York St
Manitowoc, WI 54220-4630
Phone (920) 663-9008

Other identifiers 1

IdentifierTypeStateIssuer
NONEOtherNONE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Charles.Schultz@forefrontdermatology.emadirect.md

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
I20220622001782 WI Practitioner - Pathology 0345651246 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Washington University School of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Forefront Dermatology SCGroup PAC ID 3779471701, 650 clinicians

Practice addresses (Care Compare)

801 York St
Manitowoc, WI 54220-4630
Phone (920) 683-5278

Merit-based Incentive Payment System (MIPS)

Final score
97.45 of 100Reported as group
Promoting interoperability
97
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Forefront Dermatology, S.C. CurrentSince Jun 8, 2022 Accepting new patients
Forefront Dermatology, S.C. CurrentSince Jun 8, 2022 Accepting new patients
Forefront Dermatology, S.C. Dermatopathology Current Accepting new patients

Locations

1400 Scheuring Rd
De Pere, WI 54115
Phone (920) 964-0229

1515 Randolph Ct
Manitowoc, WI 54220
Phone (920) 683-3278

801 York St
Manitowoc, WI 54220
Phone (866) 630-9882

Interoperability endpoints

  • Direct secure messaging: charles.schultz@forefrontdermatology.emadirect.md

Organizations & group practices 3

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": "1487203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704758400000",
    "number": "1356880868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 YORK ST",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542204630",
            "telephone_number": "920-663-9008",
            "fax_number": "920-684-1439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 YORK ST",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542204630",
            "telephone_number": "920-683-5278",
            "fax_number": "920-686-9674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHULTZ",
        "first_name": "CHARLES",
        "middle_name": "LEROY FREDERICK",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-02-16",
        "last_updated": "2024-01-09",
        "certification_date": "2024-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "WI",
            "license": "76987-20",
            "primary": false
        },
        {
            "code": "207ZD0900X",
            "taxonomy_group": "",
            "desc": "Pathology, Dermatopathology",
            "state": "WI",
            "license": "76987-20",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "WI",
            "license": "76987-20",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NONE",
            "identifier": "NONE",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Charles.Schultz@forefrontdermatology.emadirect.md",
            "affiliation": "N",
            "address_1": "801 York St",
            "city": "Manitowoc",
            "state": "WI",
            "country_code": "US",
            "postal_code": "542204630",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Manitowoc, WI

Sources for this page

Verify at the official NPI Registry.