NPIMap

Organization Active NPI

Bellin Memorial Hospital Inc

Doing business as Mobile Diagnostic Idtf

  • Mobile Radiology Clinic/Center
  • Green Bay, WI
National Provider Identifier
1740600600
Registry record updated Oct 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mobile Radiology Clinic/CenterTaxonomy code 261QR0208X
Legal business name
BELLIN MEMORIAL HOSPITAL INC
Doing business as
Mobile Diagnostic Idtf
Practice address
744 S Webster Ave
Green Bay, WI 54301-3505
Phone
(920) 445-7222
NPI assigned
Apr 18, 2014
Last updated
Oct 18, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2021

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

Authorized official

Name
Denise K Stroobants
Title
Credentialing Specialist
Phone
(920) 433-7864

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mobile Mammography Clinic/Center 261QR0207X WI
Mobile Radiology Clinic/Center 261QR0208X WI Primary

Addresses

Primary practice location

744 S Webster Ave
Green Bay, WI 54301-3505

Mailing address

744 S Webster Ave
Green Bay, WI 54301-3505
Phone (920) 445-7222

Other identifiers 1

IdentifierTypeStateIssuer
102970OtherWIACR CERTIFICATION

Other names 1

  • MOBILE DIAGNOSTIC IDTF Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150820010491 WI Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 8820900749 Practice locations: Green Bay, WI

Other NPIs with the same Medicare PAC ID 9

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Peshtigo Family Prac55 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Ownership & related parties

All facility ownership & control disclosures 12

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Emplify Health Oconto ClinicOconto, WI, CCN 521356 Hospital 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2021
Emplify Health Oconto HospitalOconto, WI, CCN 52Z356 Hospital 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2021
UnityDe Pere, WI, CCN 521503 Hospice 5% Or Greater Direct Ownership Interest (45%)
Limited Partnership Interest (45%)
Operational/Managerial Control (45%)		 Oct 1, 1992
Oct 1, 1992
Oct 1, 1992
Emplify Health Oconto ClinicOconto, WI, CCN 528554 Rural health clinic 5% Or Greater Indirect Ownership Interest Jun 1, 2021
Emplify Health Peshtigo ClinicPeshtigo, WI, CCN 528580 Rural health clinic 5% Or Greater Indirect Ownership Interest Nov 14, 2016
Emplify Health Crivitz ClinicCrivitz, WI, CCN 528579 Rural health clinic 5% Or Greater Indirect Ownership Interest Nov 14, 2016
Emplify Health Menominee ClinicMenominee, MI, CCN 238705 Rural health clinic 5% Or Greater Indirect Ownership Interest Nov 14, 2016
Emplify Health Daggett ClinicDaggett, MI, CCN 238704 Rural health clinic 5% Or Greater Indirect Ownership Interest Nov 14, 2016
Emplify Health Marinette ClinicMarinette, WI, CCN 528578 Rural health clinic 5% Or Greater Indirect Ownership Interest Oct 14, 2016
Emplify Health Oconto Falls ClinicOconto Falls, WI, CCN 528617 Rural health clinic 5% Or Greater Indirect Ownership Interest Oct 1, 2020
Emplify Health Lakewood ClinicLakewood, WI, CCN 528630 Rural health clinic 5% Or Greater Indirect Ownership Interest Jan 1, 2022
Emplify Health Suring ClinicSuring, WI, CCN 528631 Rural health clinic 5% Or Greater Indirect Ownership Interest Jan 19, 2022

Owned or controlled facilities with NPI records 12

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1397779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634515200000",
    "number": "1740600600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "744 S WEBSTER AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543013505",
            "telephone_number": "920-445-7222"
        },
        {
            "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": "920-445-7222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BELLIN MEMORIAL HOSPITAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-18",
        "last_updated": "2021-10-18",
        "certification_date": "2021-10-18",
        "status": "A",
        "authorized_official_last_name": "STROOBANTS",
        "authorized_official_first_name": "DENISE",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "920-433-7864"
    },
    "taxonomies": [
        {
            "code": "261QR0207X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mobile Mammography",
            "state": "WI",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0208X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mobile",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ACR CERTIFICATION",
            "identifier": "102970",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MOBILE DIAGNOSTIC IDTF",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MOBILE DIAGNOSTIC IDTF",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.