NPIMap

Organization Active NPI

Green Bay Cardiothoracic & Vascular LLC

  • Cardiovascular Disease Physician
  • Green Bay, WI
National Provider Identifier
1659412401
Registry record updated Dec 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
GREEN BAY CARDIOTHORACIC & VASCULAR LLC
Practice address
720 S Van Buren St
Suite 303
Green Bay, WI 54301-3538
Phone
(920) 433-9621
Fax
(920) 433-0565
NPI assigned
Feb 12, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2011

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

Authorized official

Name
Steven J Gerndt, MDNPI 1487667549
Title
Owner
Phone
(920) 433-9621

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
Cardiovascular Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RC0000X Primary

Addresses

Primary practice location

720 S Van Buren St
Suite 303
Green Bay, WI 54301-3538

Mailing address

720 So Van Buren St
Suite 303
Green Bay, WI 54301
Phone (920) 433-9621

Other identifiers 2

IdentifierTypeStateIssuer
32897600MedicaidWI
CG7604OtherWIRAILROAD MEDICARE

National Provider Directory

National Provider Directory

Locations

1711 S Stephenson Ave
Ste 205
Iron Mountain, MI 49801
Phone (866) 433-9621

720 S Van Buren St
Ste 303
Green Bay, WI 54301
Phone (920) 433-9621

3100 Shore Dr
Ste 104
Marinette, WI 54143
Phone (715) 735-6621

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323820800000",
    "number": "1659412401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 SO VAN BUREN ST",
            "address_2": "SUITE 303",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "54301",
            "telephone_number": "920-433-9621",
            "fax_number": "920-433-0565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 S VAN BUREN ST",
            "address_2": "SUITE 303",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543013538",
            "telephone_number": "920-433-9621",
            "fax_number": "920-433-0565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN BAY CARDIOTHORACIC & VASCULAR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-12",
        "last_updated": "2011-12-14",
        "status": "A",
        "authorized_official_last_name": "GERNDT",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "920-433-9621",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32897600",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CG7604",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.