NPIMap

Individual provider Active NPI

David L Groteluschen, M.D.

  • Medical Oncology Physician
  • Green Bay, WI
National Provider Identifier
1679538011
Registry record updated Dec 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Oncology PhysicianTaxonomy code 207RX0202X
License
44953 Issued in WI
Practice address
1726 Shawano Ave
Green Bay, WI 54303-3216
Phone
(920) 884-3135
Fax
(920) 884-3144
NPI assigned
Apr 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Oncology Physician 207RX0202X 44953 WI Primary

Addresses

Primary practice location

1726 Shawano Ave
Green Bay, WI 54303-3216

Mailing address

1726 Shawano Ave
Green Bay, WI 54303-3216
Phone (920) 884-3135

Other identifiers 3

IdentifierTypeStateIssuer
34871500MedicaidWI
104894036MedicaidMI
DG088696OtherMIMICHIGAN BCBS

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address dgroteluschen10949@ewd.direct.hshs.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, MI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20060726000134 WI Practitioner - Hematology/OncologyPractitioner - Internal Medicine 3971516519 Reassigns benefits to 2 organizations
I20060804000242 MI Practitioner - Hematology/OncologyPractitioner - Internal Medicine 3971516519 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Hematology/OncologyAlso: Internal Medicine
Education
University of Iowa, RJ & L Carver College of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ascension NE Wisconsin, IncGroup PAC ID 7719897784, 19 clinicians

Practice addresses (Care Compare)

1506 S Oneida St
Appleton, WI 54915-1305
Phone (920) 738-2000

835 S Van Buren St
Green Bay, WI 54301-3526
Phone (920) 433-0111

Hospital & facility affiliations

  • Unity Hospice Hospice, De Pere, WI, CCN 521503
  • St Vincent Hospital Hospital, Green Bay, WI, CCN 520075
  • St Marys Hospital Medical Ctr Hospital, Green Bay, WI, CCN 520097
  • Door County Medical Center Hospital, Sturgeon Bay, WI, CCN 521358
  • Ascension NE Wisconsin - St Elizabeth Campus Hospital, Appleton, WI, CCN 520009
  • St Nicholas Hospital Hospital, Sheboygan, WI, CCN 520044

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
97.16
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
94.81 of 100Reported as apm
Quality
85.98
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
44953WIMDMedical Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ascension NE Wisconsin, Inc CurrentSince Jan 15, 2016 Accepting new patients
Osf Multi-Specialty Group CurrentSince Oct 23, 2024 Accepting new patients
St. Vincent Hospital-Hospital Sisters-Third Order of St. Francis CurrentSince Jun 1, 2015 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis CurrentSince Jun 1, 2015 Accepting new patients
Ascension NE Wisconsin, Inc CurrentSince Jan 15, 2016 Accepting new patients
Schoolcraft Memorial Hospital CurrentSince Oct 28, 2024 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis Current Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis Past Accepting new patients

Locations

2525 5th Ave S
Escanaba, MI 49829
Phone (906) 233-4276

3409 Ludington St
Ste 200
Escanaba, MI 49829
Phone (906) 786-7600

7870W US Highway 2
Manistique, MI 49854
Phone (906) 341-2153

1506 S Oneida St
Appleton, WI 54915
Phone (920) 730-4950

1726 Shawano Ave
Green Bay, WI 54303
Phone (920) 432-6016

835 S Van Buren St
Green Bay, WI 54301
Phone (888) 901-7246

2300 Western Ave
Manitowoc, WI 54220
Phone (920) 320-2011

Organizations & group practices 8

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

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1145404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639958400000",
    "number": "1679538011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1726 SHAWANO AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543033216",
            "telephone_number": "920-884-3135",
            "fax_number": "920-884-3144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1726 SHAWANO AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543033216",
            "telephone_number": "920-884-3135",
            "fax_number": "920-884-3144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GROTELUSCHEN",
        "first_name": "DAVID",
        "middle_name": "L",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-19",
        "last_updated": "2021-12-20",
        "certification_date": "2021-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RX0202X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Medical Oncology",
            "state": "WI",
            "license": "44953",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34871500",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104894036",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MICHIGAN BCBS",
            "identifier": "DG088696",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dgroteluschen10949@ewd.direct.hshs.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "1726 Shawano Ave",
            "city": "Green Bay",
            "state": "WI",
            "country_code": "US",
            "postal_code": "543033216",
            "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.