Froedtert Manitowoc Medical Group, LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

FROEDTERT MANITOWOC MEDICAL GROUP, LLC

Doing business as

Froedtert Northeast Medical Group

Practice address

2300 Western Ave
Manitowoc, WI 54220-3712

Phone

(920) 320-2436

NPI assigned

Sep 16, 2021

Last updated

Jul 7, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Michael W Degere, DPM

Title

Secretary/Treasurer

Phone

(920) 320-2095

Specialties & licenses 2

Addresses

Other names 1

• Froedtert Northeast Medical Group Doing business as

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Holy Family Memorial Inc

  dba Froedtert Holy Family Memorial

  • Home Health Agency
  • Manitowoc, WI
  • NPI 1174629075

  Member Of

  NPD member

Locations

Practitioners 389

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Khalid Adam Abdelgadir, MD

  • Internal Medicine Physician
  • Manitowoc, WI
  • NPI 1407433295
  Medicare reassignment Care Compare group NPD
• Michael G Aderman, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Manitowoc, WI
  • NPI 1033965561
  Medicare reassignment Care Compare group NPD
• Abdulmohsin M Ahmadjee, M.D

  • Cardiovascular Disease Physician
  • Appleton, WI
  • NPI 1225370802
  Medicare reassignment Care Compare group NPD
• Olivia C. Alexander, MA, LPC

  • Professional Counselor
  • Manitowoc, WI
  • NPI 1508351321
  Medicare reassignment Care Compare group NPD
• Jeremy Robert Anclam, D.O.

  • Gastroenterology Physician
  • Manitowoc, WI
  • NPI 1841495058

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• Nicole Artamenko, FNP-C

  • Family Nurse Practitioner
  • Manitowoc, WI
  • NPI 1083312409
  Medicare reassignment Care Compare group NPD
• Aleem Bakhtiar, M.D.

  • Emergency Medicine Physician
  • Oshkosh, WI
  • NPI 1053706044
  Medicare reassignment Care Compare group NPD
• Samuel Quinn Ballard, DO

  • Internal Medicine Physician
  • Two Rivers, WI
  • NPI 1578191763
  Medicare reassignment Care Compare group NPD
• Krista Lyn Begley, AUD

  • Audiologist
  • Sheboygan, WI
  • NPI 1174140115
  Medicare reassignment Care Compare group NPD
• Julia D. Bell, AUD

  • Audiologist
  • Sheboygan, WI
  • NPI 1508858929
  Medicare reassignment Care Compare group NPD
• Valerie Jean Bonne, M.D.

  • Pulmonary Disease Physician
  • Milwaukee, WI
  • NPI 1407936016
  Medicare reassignment Care Compare group NPD
• Brian L Boomgarden, MS CADC

  • Mental Health Counselor
  • Manitowoc, WI
  • NPI 1871510677
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1631750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751846400000",
    "number": "1437829975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 WOODLAND PRIME STE 103",
            "address_2": "N74 W12501 LEATHERWOOD COURT",
            "city": "MENOMONEE FALLS",
            "state": "WI",
            "postal_code": "530514490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 WESTERN AVE",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542203712",
            "telephone_number": "920-320-2436"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1414 N Taylor Dr",
            "address_purpose": "LOCATION",
            "city": "Sheboygan",
            "state": "WI",
            "postal_code": "530811988",
            "country_code": "US",
            "telephone_number": "920-320-2011",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2631 Eastern Ave",
            "address_purpose": "LOCATION",
            "city": "Plymouth",
            "state": "WI",
            "postal_code": "530734270",
            "country_code": "US",
            "telephone_number": "920-320-2436",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "800 Lakefront Way",
            "address_purpose": "LOCATION",
            "city": "Two Rivers",
            "state": "WI",
            "postal_code": "542413301",
            "country_code": "US",
            "telephone_number": "920-320-2011",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4303 Michigan Ave",
            "address_purpose": "LOCATION",
            "city": "Manitowoc",
            "state": "WI",
            "postal_code": "542203066",
            "country_code": "US",
            "telephone_number": "920-320-2011",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1650 S 41st St",
            "address_purpose": "LOCATION",
            "city": "Manitowoc",
            "state": "WI",
            "postal_code": "542207316",
            "country_code": "US",
            "telephone_number": "920-320-2011",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1635 S 21st St",
            "address_purpose": "LOCATION",
            "city": "Manitowoc",
            "state": "WI",
            "postal_code": "542206380",
            "country_code": "US",
            "telephone_number": "920-320-2011",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "339 Reed Ave",
            "address_purpose": "LOCATION",
            "city": "Manitowoc",
            "state": "WI",
            "postal_code": "542202020",
            "country_code": "US",
            "telephone_number": "920-320-2011",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1081 E Johnson St",
            "address_purpose": "LOCATION",
            "city": "Fond Du Lac",
            "state": "WI",
            "postal_code": "549358919",
            "country_code": "US",
            "telephone_number": "920-367-6700",
            "fax_number": "262-799-4657",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3736 S Taylor Dr",
            "address_purpose": "LOCATION",
            "city": "Sheboygan",
            "state": "WI",
            "postal_code": "530818432",
            "country_code": "US",
            "telephone_number": "920-476-6300",
            "fax_number": "920-328-1403",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FROEDTERT MANITOWOC MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-16",
        "last_updated": "2025-07-07",
        "certification_date": "2025-07-07",
        "status": "A",
        "authorized_official_last_name": "DEGERE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "SECRETARY/TREASURER",
        "authorized_official_telephone_number": "920-320-2095",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Froedtert Northeast Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jennifer Sue Franzen, RDN
• Michelle Freiberg
• Froedtert Health (Froedtert & MCW Community Physicians)
• Froedtert Health Pharmacy LLC (Froedtert Pharmacy 375)
• Froedtert Health Pharmacy, LLC (Froedtert Pharmacy 375)
• Margaret Grace Fuhrman, PA-C
• Lori M Fure, LCSW
• Amy Dolores Furhmann, PHYSICAL THERAPIST
• Kelly Gagnon
• Tammi S Gags, PA

• Multi-Specialty Clinic/Center in Manitowoc, WI
• Providers in Manitowoc, WI by specialty
• Multi-Specialty Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.