Shelley Boehm Mattia MD,Adult Psychiatry, LLC

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

License

39641 Issued in WI

Legal business name

SHELLEY BOEHM MATTIA MD,ADULT PSYCHIATRY, LLC

Practice address

428 Doty St
Green Bay, WI 54301-4509

Phone

(920) 965-6768

Fax

(920) 965-6769

NPI assigned

Mar 24, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Shelley Kathryn Boehm Mattia, M.D.NPI 1073662938

Title

Licensed Physician

Phone

(920) 246-4925

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shelley Boehm Mattia, M.D.

  • Psychiatry Physician
  • Waunakee, WI
  • NPI 1073662938

  Adult Mental Health, WI

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1458777600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475539200000",
    "number": "1427410992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "428 DOTY ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543014509",
            "telephone_number": "920-965-6768",
            "fax_number": "920-965-6769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "428 DOTY ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543014509",
            "telephone_number": "920-965-6768",
            "fax_number": "920-965-6769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHELLEY BOEHM MATTIA MD,ADULT PSYCHIATRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-24",
        "last_updated": "2016-10-04",
        "status": "A",
        "authorized_official_last_name": "BOEHM MATTIA",
        "authorized_official_first_name": "SHELLEY",
        "authorized_official_middle_name": "KATHRYN",
        "authorized_official_title_or_position": "LICENSED PHYSICIAN",
        "authorized_official_telephone_number": "920-246-4925",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "WI",
            "license": "39641",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32453500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lisa Rae Shefchik, DC
• Marcia A. Shefchik, RN
• Nicole Marie Shefchik, M.S. CCC-SLP
• Steve A Shefchik, MA, LPC
• Taylor Lauren Shefchik, PA-C
• Kyra Shelley, AUD
• Paul M Shen, MD
• Robin L Shepard, RN
• Kevin H Shepet, M.D.
• Frederick Knight Sheppard, DC

• All providers in Green Bay, WI
• Adult Mental Health Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.