NPIMap

Organization Active NPI

GBR Sheboygan LLC

  • Diagnostic Radiology Physician
  • Sheboygan, WI
National Provider Identifier
1467529917
Registry record updated May 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
GBR SHEBOYGAN LLC
Practice address
3100 Superior Ave
Sheboygan, WI 53081-1948
Phone
(920) 964-0480
Fax
(920) 336-8093
NPI assigned
Nov 29, 2006
Last updated
May 29, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2026

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

Authorized official

Name
Jimmy Dado Jr.
Title
Director of Revenue Cycle
Phone
(614) 325-8899

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X WI Primary
Vascular & Interventional Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0204X WI

Addresses

Primary practice location

3100 Superior Ave
Sheboygan, WI 53081-1948

Mailing address

2941 S Ridge Rd
Green Bay, WI 54304-5517
Phone (920) 336-4096

Other identifiers 1

IdentifierTypeStateIssuer
21284500MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, MI, AZ, MN, IL, TX, DC7 enrollments

Enrollment records 7

Enrollment IDStateProvider typePAC IDDetails
O20050509000490 WI Part B Supplier - Clinic/Group Practice 1951341064 Receives reassigned benefits from 27 practitioners
Practice locations: Appleton, WI; Green Bay, WI; Marinette, WI; Sheboygan, WI
O20220127001945 MI Part B Supplier - Clinic/Group Practice 1951341064 Receives reassigned benefits from 1 practitioner
Practice locations: Bloomfield Hills, MI
O20221209002653 AZ Part B Supplier - Clinic/Group Practice 1951341064 Receives reassigned benefits from 2 practitioners
Practice locations: Phoenix, AZ; Tucson, AZ
O20231117002061 MN Part B Supplier - Clinic/Group Practice 1951341064 Receives reassigned benefits from 1 practitioner
Practice locations: Saint Paul, MN
O20240208001165 IL Part B Supplier - Clinic/Group Practice 1951341064 Receives reassigned benefits from 1 practitioner
Practice locations: Skokie, IL
O20240228000174 TX Part B Supplier - Clinic/Group Practice 1951341064 Receives reassigned benefits from 1 practitioner
Practice locations: San Antonio, TX
O20241029002461 DC Part B Supplier - Clinic/Group Practice 1951341064 Receives reassigned benefits from 1 practitioner
Practice locations: Potomac, MD

National Provider Directory

National Provider Directory

Member of 1

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

Practitioners & affiliated clinicians

Practitioners 35

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.

View all 35

NPI Registry JSON

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1780012800000",
    "number": "1467529917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2941 S RIDGE RD",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543045517",
            "telephone_number": "920-336-4096",
            "fax_number": "920-336-8093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 SUPERIOR AVE",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "530811948",
            "telephone_number": "920-964-0480",
            "fax_number": "920-336-8093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GBR SHEBOYGAN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-29",
        "last_updated": "2026-05-29",
        "certification_date": "2026-05-29",
        "status": "A",
        "authorized_official_last_name": "DADO",
        "authorized_official_first_name": "JIMMY",
        "authorized_official_title_or_position": "DIRECTOR OF REVENUE CYCLE",
        "authorized_official_telephone_number": "614-325-8899",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WI",
            "license": null,
            "primary": true
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "WI",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "21284500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sheboygan, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2026; 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.