NPIMap

Organization Active NPI

Radiology Chartered

  • Diagnostic Radiology Physician
  • Green Bay, WI
National Provider Identifier
1760416895
Registry record updated Jun 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
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
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2023

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)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 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

Other identifiers 3

IdentifierTypeStateIssuer
C04047OtherWIRR MEDICARE
32725000MedicaidWI
000007273OtherWIPTAN

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, NC17 enrollments

Enrollment records 17

Enrollment IDStateProvider typePAC IDDetails
O20050915000492 WI Part B Supplier - Clinic/Group Practice 1557394988 Receives reassigned benefits from 15 practitioners
Practice locations: Green Bay, WI
O20230629003693 MI Part B Supplier - Clinic/Group Practice 1557394988 Receives reassigned benefits from 15 practitioners
Practice locations: Marquette, MI
O20240118001887 RI Part B Supplier - Clinic/Group Practice 1557394988 Receives reassigned benefits from 1 practitioner
Practice locations: East Greenwich, RI
O20240118001934 CA Part B Supplier - Clinic/Group Practice 1557394988 Receives reassigned benefits from 5 practitioners
Practice locations: Cambria, CA; Cupertino, CA; Long Beach, CA; Rancho Santa Fe, CA; Rocklin, CA; Santa Monica, CA; Sunnyvale, CA
O20240220003695 GA Part B Supplier - Clinic/Group Practice 1557394988 Receives reassigned benefits from 1 practitioner
Practice locations: Cumming, GA; Lilburn, GA
O20240321000486 MA Part B Supplier - Clinic/Group Practice 1557394988 Receives reassigned benefits from 1 practitioner
Practice locations: Newbury, MA; Jamaica Plain, MA
O20240620000013 IL Part B Supplier - Clinic/Group Practice 1557394988 Practice locations: Oak Brook, IL; Oak Park, IL; Chicago, IL
O20250827004064 ME Part B Supplier - Clinic/Group Practice 1557394988 Practice locations: South Portland, ME
O20250902000719 MN Part B Supplier - Clinic/Group Practice 1557394988 Receives reassigned benefits from 18 practitioners
Practice locations: Eden Prairie, MN; Woodbury, MN; Wayzata, MN; Rochester, MN; Minneapolis, MN; Medina, MN; Maple Grove, MN
O20250913000546 TX Part B Supplier - Clinic/Group Practice 1557394988 Receives reassigned benefits from 1 practitioner
Practice locations: The Woodlands, TX
O20250926000746 FL Part B Supplier - Clinic/Group Practice 1557394988 Receives reassigned benefits from 3 practitioners
Practice locations: Orlando, FL
O20251003003756 WA Part B Supplier - Clinic/Group Practice 1557394988 Receives reassigned benefits from 5 practitioners
Practice locations: Spokane, WA
O20251014001546 AZ Part B Supplier - Clinic/Group Practice 1557394988 Receives reassigned benefits from 1 practitioner
Practice locations: Scottsdale, AZ
O20251021000313 KY Part B Supplier - Clinic/Group Practice 1557394988 Receives reassigned benefits from 1 practitioner
Practice locations: Louisville, KY
O20251029000695 MO Part B Supplier - Clinic/Group Practice 1557394988 Receives reassigned benefits from 1 practitioner
Practice locations: Saint Joseph, MO
O20251119002226 IA Part B Supplier - Clinic/Group Practice 1557394988 Receives reassigned benefits from 1 practitioner
Practice locations: Orange City, IA
O20260317000697 NC Part B Supplier - Clinic/Group Practice 1557394988 Receives reassigned benefits from 1 practitioner
Practice locations: Concord, NC

National Provider Directory

National Provider Directory

Locations

1789 Shawano Ave
Green Bay, WI 54303

740 S Van Buren St
Green Bay, WI 54301
Phone (920) 433-3411

Practitioners & affiliated clinicians

Practitioners 66

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 66

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": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "C04047",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32725000",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "000007273",
            "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 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.

Verify at the official NPI Registry.