Active NPI
Radiology Chartered
- Diagnostic Radiology Physician
- Green Bay, WI
National Provider Identifier
1760416895
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- Legal business name
- RADIOLOGY CHARTERED
- Practice address
- 1789 Shawano Ave
Green Bay, WI 54303-3243 - Phone
- (920) 499-1428
- Fax
- (920) 499-7080
- NPI assigned
- Jul 11, 2006
- Last updated
- Jun 15, 2023
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ms. Shaniece Brabant
- Title
- Office Manager
- Phone
- (920) 499-2766
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | Primary |
Addresses
Primary practice location
1789 Shawano Ave
Green Bay, WI 54303-3243
Mailing address
1789 Shawano Ave
Green Bay, WI 54303-3243
Phone (920) 499-1428
Other practice location 1
325 Bishop Woods Rd
Marquette, MI 49855-8606
Phone (920) 499-1428
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI, MI, RI, CA, GA, MA, IL, ME, MN, TX, FL, WA, AZ, KY, MO, IA, NC
Enrollment records 17
National Provider Directory
National Provider DirectoryLocations
1789 Shawano Ave
Green Bay, WI 54303
Phone (920) 494-2310
740 S Van Buren St
Green Bay, WI 54301
Phone (920) 433-3411
Practitioners & affiliated clinicians
Practitioners 68
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": "1152576000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1686787200000",
"number": "1760416895",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1789 SHAWANO AVE",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543033243",
"telephone_number": "920-499-1428",
"fax_number": "920-499-7080"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1789 SHAWANO AVE",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543033243",
"telephone_number": "920-499-1428",
"fax_number": "920-499-7080"
}
],
"practiceLocations": [
{
"address_1": "325 Bishop Woods Rd",
"address_purpose": "LOCATION",
"city": "Marquette",
"state": "MI",
"postal_code": "498558606",
"country_code": "US",
"telephone_number": "920-499-1428",
"fax_number": "920-499-7080",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "RADIOLOGY CHARTERED",
"organizational_subpart": "NO",
"enumeration_date": "2006-07-11",
"last_updated": "2023-06-15",
"certification_date": "2023-06-15",
"status": "A",
"authorized_official_last_name": "BRABANT",
"authorized_official_first_name": "SHANIECE",
"authorized_official_title_or_position": "OFFICE MANAGER",
"authorized_official_telephone_number": "920-499-2766",
"authorized_official_name_prefix": "Ms."
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Radiology, Diagnostic Radiology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"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 Jun 15, 2023; 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.