NPIMap

Organization Active NPI

Sheboygan Physicians Group, SC

  • Internal Medicine Physician
  • Sheboygan, WI
National Provider Identifier
1477819902
Registry record updated Oct 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
SHEBOYGAN PHYSICIANS GROUP, SC
Practice address
2920 Superior Ave
Sheboygan, WI 53081-1944
Phone
(920) 452-6000
Fax
(920) 803-2990
NPI assigned
Apr 10, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2022

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

Authorized official

Name
Kelley Renzelmann
Title
Administrator
Phone
(920) 452-6000

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Medical Oncology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RX0202X

Addresses

Primary practice location

2920 Superior Ave
Sheboygan, WI 53081-1944

Mailing address

2920 Superior Ave
Sheboygan, WI 53081-1944
Phone (920) 452-6000

Other practice location 1

1621 N Taylor Dr
Sheboygan, WI 53081-1990
Phone (920) 453-5432

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120705000087 WI Part B Supplier - Clinic/Group Practice 0648435214 Receives reassigned benefits from 22 practitioners
Practice locations: Sheboygan, WI; Sheboygan Falls, WI; Waldo, WI; Cedar Grove, WI; Elkhart Lake, WI; Howards Grove, WI; Plymouth, WI; Port Washington, WI…

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
52D0914318Sheboygan Physicians Group, SC1621 N Taylor Dr, Sheboygan, WI 53081AccreditationJun 13, 2028

National Provider Directory

National Provider Directory

Locations

2004 Appletree Rd
Howards Grove, WI 53083
Phone (920) 550-3039

701 Pine Dr
Oostburg, WI 53070
Phone (920) 467-2401

2653 Valley Rd
Plymouth, WI 53073
Phone (920) 892-8324

305 S Spring St
#A
Random Lake, WI 53075
Phone (920) 994-8304

305 S Spring St
Random Lake, WI 53075
Phone (920) 994-8304

2920 Superior Ave
Sheboygan, WI 53081
Phone (920) 452-6000

3505 County Road Y
Sheboygan, WI 53083
Phone (920) 458-2137

Practitioners & affiliated clinicians

Practitioners 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1334016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665446400000",
    "number": "1477819902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2920 SUPERIOR AVE",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "530811944",
            "telephone_number": "920-452-6000",
            "fax_number": "920-803-2990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2920 SUPERIOR AVE",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "530811944",
            "telephone_number": "920-452-6000",
            "fax_number": "920-803-2990"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1621 N Taylor Dr",
            "address_purpose": "LOCATION",
            "city": "Sheboygan",
            "state": "WI",
            "postal_code": "530811990",
            "country_code": "US",
            "telephone_number": "920-453-5432",
            "fax_number": "920-452-3594",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SHEBOYGAN PHYSICIANS GROUP, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-10",
        "last_updated": "2022-10-11",
        "certification_date": "2021-12-21",
        "status": "A",
        "authorized_official_last_name": "RENZELMANN",
        "authorized_official_first_name": "KELLEY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "920-452-6000"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RX0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Medical Oncology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "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 Oct 11, 2022; 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.