NPIMap

Organization Active NPI

Orthopedic & Spine Therapy of Green Bay, SC

  • Physical Therapist
  • De Pere, WI
National Provider Identifier
1558477307
Registry record updated May 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
ORTHOPEDIC & SPINE THERAPY OF GREEN BAY, SC
Practice address
301 N Broadway Ste 206
De Pere, WI 54115-2557
Phone
(920) 432-9040
Fax
(920) 432-9053
NPI assigned
Aug 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2025

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

Authorized official

Name
Paul Steven Barnett, PTNPI 1154368777
Title
Owner-President
Phone
(920) 257-2000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X WI Primary

Addresses

Primary practice location

301 N Broadway Ste 206
De Pere, WI 54115-2557

Mailing address

4000 N. Providence Avenue
Appleton, WI 54913-8018
Phone (920) 257-2000

Other identifiers 4

IdentifierTypeStateIssuer
CI9565OtherWIRAILROAD MEDICARE
40415100MedicaidWI
369376100OtherWIUS DEPARTMENT OF LABOR
41745600MedicaidWI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040130000723 WI Part B Supplier - Physical/Occupational Therapy Group in Private Practice 3072416502 Receives reassigned benefits from 11 practitioners
1 other NPI on this enrollment
Practice locations: De Pere, WI

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

211 N Broadway
Ste 105
Green Bay, WI 54303
Phone (920) 431-7839

Practitioners & affiliated clinicians

Practitioners 11

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

NPI Registry JSON

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

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747353600000",
    "number": "1558477307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 N. PROVIDENCE AVENUE",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549138018",
            "telephone_number": "920-257-2000",
            "fax_number": "920-257-2004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 N BROADWAY STE 206",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541152557",
            "telephone_number": "920-432-9040",
            "fax_number": "920-432-9053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOPEDIC & SPINE THERAPY OF GREEN BAY, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-22",
        "last_updated": "2025-05-16",
        "certification_date": "2025-05-16",
        "status": "A",
        "authorized_official_last_name": "BARNETT",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "STEVEN",
        "authorized_official_title_or_position": "OWNER-PRESIDENT",
        "authorized_official_telephone_number": "920-257-2000",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CI9565",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40415100",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "US DEPARTMENT OF LABOR",
            "identifier": "369376100",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41745600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in De Pere, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2025; 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.