NPIMap

Organization Active NPI

Pathology Consultants of Green Bay, S.C.

  • Anatomic Pathology & Clinical Pathology Physician
  • Green Bay, WI
National Provider Identifier
1710938352
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
Legal business name
PATHOLOGY CONSULTANTS OF GREEN BAY, S.C.
Practice address
744 S Webster Ave
Green Bay, WI 54301-3505
Phone
(920) 433-3653
NPI assigned
May 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Thomas S Fredeen, M.D.
Title
President
Phone
(920) 433-3653

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207ZP0102X Primary

Addresses

Primary practice location

744 S Webster Ave
Green Bay, WI 54301-3505

Mailing address

200 E Washington St
P O Box 8031
Appleton, WI 54911-5490
Phone (800) 236-1489

Other identifiers 1

IdentifierTypeStateIssuer
32692200MedicaidWI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040401001265 WI Part B Supplier - Clinic/Group Practice 5395737019 Receives reassigned benefits from 6 practitioners
Practice locations: Green Bay, WI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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": "1147651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1710938352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 E WASHINGTON ST",
            "address_2": "P O BOX 8031",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549115490",
            "telephone_number": "800-236-1489",
            "fax_number": "920-739-0124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "744 S WEBSTER AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543013505",
            "telephone_number": "920-433-3653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATHOLOGY CONSULTANTS OF GREEN BAY, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FREDEEN",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "920-433-3653",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32692200",
            "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 Aug 22, 2020; 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.