Individual provider Active NPI

Bryahna Rambo, MD

  • Family Medicine Physician
  • Green Bay, WI
National Provider Identifier
1558987362
Registry record updated Jul 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
81982 Issued in WI
Practice address
4070 Equestrian LN
Green Bay, WI 54229-9649
Phone
(920) 866-6100
NPI assigned
Jun 18, 2020
Last updated
Jul 10, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4351046866 MI
Family Medicine Physician 207Q00000X 81982 WI Primary

Addresses

Primary practice location

4070 Equestrian LN
Green Bay, WI 54229-9649

Mailing address

PO Box 735044
Chicago, IL 60673-5044
Phone (920) 866-6100

Other practice location 1

650 Stewart Rd
Monroe, MI 48162-4222
Phone (734) 240-8430

Other identifiers 1

IdentifierTypeStateIssuer
100239108MedicaidWI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address bryahna.rambo@promedica.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230628000073 WI Practitioner - Family Practice 6901264639 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians

Practice addresses (Care Compare)

4070 Equestrian LN
Green Bay, WI 54229-9649
Phone (920) 866-6100

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4351046866MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Medical Group, Inc. CurrentSince Jul 14, 2023 Accepting new patients
Aurora Medical Group, Inc. Family Medicine CurrentSince Jul 14, 2023 Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients

Locations

4070 Equestrian Ln
Green Bay, WI 54229
Phone (920) 866-6100

1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1592438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688947200000",
    "number": "1558987362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 735044",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606735044",
            "telephone_number": "920-866-6100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4070 EQUESTRIAN LN",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "542299649",
            "telephone_number": "920-866-6100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "650 Stewart Rd",
            "address_purpose": "LOCATION",
            "city": "Monroe",
            "state": "MI",
            "postal_code": "481624222",
            "country_code": "US",
            "telephone_number": "734-240-8430",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RAMBO",
        "first_name": "BRYAHNA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-18",
        "last_updated": "2023-07-10",
        "certification_date": "2023-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4351046866",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "81982",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100239108",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bryahna.rambo@promedica.org",
            "affiliation": "N",
            "endpointDescription": "email",
            "address_1": "650 Stewart Rd",
            "city": "Monroe",
            "state": "MI",
            "country_code": "US",
            "postal_code": "481624222",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.