Active NPI
Randi Mann, NP
- Nurse Practitioner
- Green Bay, WI
National Provider Identifier
1427016609
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 115033
- Practice address
- 2641 Development Drive
Green Bay, WI 54311 - Phone
- (920) 338-6868
- Fax
- (920) 338-6869
- NPI assigned
- May 3, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 115033 | WI | Primary |
Addresses
Primary practice location
2641 Development Drive
Green Bay, WI 54311
Mailing address
PO Box 5277
De Pere, WI 54115-5277
Phone (920) 338-6868
Other names 1
- Randi Burnham
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
- Opted out of Medicare
- Yes, effective Jun 25, 2018 through Jun 25, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 115033 | WI | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bellin Memorial Hospital Inc | Past | Accepting new patients | |
| Wise Woman Wellness LLC | Past | Accepting new patients | |
| Bellin Memorial Hospital Inc | Past | Accepting new patients |
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.
-
- Women's Health Nurse Practitioner
- De Pere, WI
- NPI 1033447594
-
dba Bellin Health
- Family Medicine Physician
- Green Bay, WI
- NPI 1033172390
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146614400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1251072000000",
"number": "1427016609",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5277",
"city": "DE PERE",
"state": "WI",
"postal_code": "541155277",
"telephone_number": "920-338-6868",
"fax_number": "920-338-6869"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2641 DEVELOPMENT DRIVE",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "54311",
"telephone_number": "920-338-6868",
"fax_number": "920-338-6869"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANN",
"first_name": "RANDI",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-03",
"last_updated": "2009-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "WI",
"license": "115033",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "RANDI",
"last_name": "BURNHAM",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Green Bay, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.