Individual provider Active NPI

Robert David Southwick, MD

  • Obstetrics & Gynecology Physician
  • Green Bay, WI
National Provider Identifier
1417975087
Registry record updated Nov 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
37060 Issued in WI
Practice address
2253 W Mason St
Green Bay, WI 54303-4706
Phone
(920) 327-7300
NPI assigned
Jul 18, 2006
Last updated
Nov 24, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 24, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 37060 WI Primary

Addresses

Primary practice location

2253 W Mason St
Green Bay, WI 54303-4706

Mailing address

2253 W Mason St
Green Bay, WI 54303-4706
Phone (920) 327-7300

Other identifiers 1

IdentifierTypeStateIssuer
32424200MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address rsouthwick57711@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

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
I20050922001171 WI Practitioner - Obstetrics/Gynecology 8123052735 Reassigns benefits to 4 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
37060WIMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeshore Medical Clinic, LLC CurrentSince Jun 25, 2018 Accepting new patients
Aurora Advanced Healthcare, Inc. Obstetrics & Gynecology CurrentSince Jun 25, 2018 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Sep 1, 2009 Accepting new patients
Aurora Medical Group, Inc. Obstetrics & Gynecology CurrentSince Sep 1, 2009 Accepting new patients
Aurora Advanced Healthcare Inc CurrentSince Jun 25, 2018 Accepting new patients
Obhg Wisconsin, S.C. Obstetrics & Gynecology CurrentSince Jan 24, 2018 Accepting new patients

Locations

12500 W Bluemound Rd
Elm Grove, WI 53122
Phone (262) 780-3434

210 Wisconsin American Dr
Fond du Lac, WI 54937
Phone (920) 907-7000

3003 W Good Hope Rd
Glendale, WI 53209
Phone (414) 352-3100

123 N Military Ave
Green Bay, WI 54303
Phone (920) 494-3421

2253 W Mason St
Green Bay, WI 54303
Phone (920) 327-7000

2733 S Ridge Rd
Green Bay, WI 54304
Phone (920) 497-6200

2845 Greenbrier Rd
#4
Green Bay, WI 54311
Phone (920) 288-8400

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

12203 N Corporate Pkwy
Mequon, WI 53092
Phone (262) 387-8200

1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056

S74W16775 Janesville Rd
Muskego, WI 53150
Phone (414) 422-4747

855 N Westhaven Dr
Oshkosh, WI 54904
Phone (920) 451-5643

2000 E Layton Ave
St Francis, WI 53235
Phone (414) 744-7880

8901 W Lincoln Ave
West Allis, WI 53227
Phone (414) 328-6000

Interoperability endpoints

  • Direct secure messaging: rsouthwick57711@direct.myadvocateaurora.org

Organizations & group practices 6

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": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637712000000",
    "number": "1417975087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2253 W MASON ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543034706",
            "telephone_number": "920-327-7300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2253 W MASON ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543034706",
            "telephone_number": "920-327-7300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUTHWICK",
        "first_name": "ROBERT",
        "middle_name": "DAVID",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-18",
        "last_updated": "2021-11-24",
        "certification_date": "2021-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "WI",
            "license": "37060",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32424200",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rsouthwick57711@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2253 W Mason St",
            "city": "Green Bay",
            "state": "WI",
            "country_code": "US",
            "postal_code": "543034706",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "2253 W Mason St",
            "city": "Green Bay",
            "state": "WI",
            "country_code": "US",
            "postal_code": "543034706",
            "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.