NPIMap

Individual provider Active NPI

Shelby Lynne Vanrossum, MD

  • Family Medicine Physician
  • Green Bay, WI
National Provider Identifier
1801475256
Registry record updated Dec 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
77773-20 Issued in WI
Practice address
3021 Voyager Dr
Green Bay, WI 54311-8303
Phone
(920) 496-4700
NPI assigned
Apr 5, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 77773-20 WI Primary

Addresses

Primary practice location

3021 Voyager Dr
Green Bay, WI 54311-8303

Mailing address

PO Box 19070
Green Bay, WI 54307-9070
Phone (920) 496-4700

Other identifiers 1

IdentifierTypeStateIssuer
100226310MedicaidWI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address svanrossum200552@ewd.direct.hshs.org Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240807004109 WI Practitioner - Family Practice 1052782471 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Medical College of Wisconsin, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3021 Voyager Dr
Green Bay, WI 54311-8303
Phone (920) 496-4700

Hospital & facility affiliations

  • HSHS Home Care Wisconsin Home health agency, Green Bay, WI, CCN 527132
  • St Vincent Hospital Hospital, Green Bay, WI, CCN 520075
  • St Marys Hospital Medical Ctr Hospital, Green Bay, WI, CCN 520097

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
77773-20WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prevea Clinic, Inc. Family Medicine CurrentSince Jul 1, 2024 Accepting new patients
St Nicholas Hospital-Sisters of the Third Order of St Francis CurrentSince Jul 1, 2024 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis CurrentSince Jul 1, 2024 Accepting new patients
Prevea Clinic, Inc. Family Medicine CurrentSince Jul 1, 2024 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis Family Medicine Current Accepting new patients
St. Nicholas Hospital-Sisters of the Third Order of St Francis Family Medicine CurrentSince Jul 1, 2024 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis CurrentSince Jul 1, 2024 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis Past Accepting new patients

Locations

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

3021 Voyager Dr
Green Bay, WI 54311
Phone (920) 431-1810

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

3100 Superior Ave
Sheboygan, WI 53081
Phone (800) 472-6710

Interoperability endpoints

  • Direct secure messaging: svanrossum113844@direct.ascension.org

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 7

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

NPI Registry JSON

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

{
    "created_epoch": "1617580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734480000000",
    "number": "1801475256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19070",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543079070",
            "telephone_number": "920-496-4700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3021 VOYAGER DR",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543118303",
            "telephone_number": "920-496-4700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANROSSUM",
        "first_name": "SHELBY",
        "middle_name": "LYNNE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-05",
        "last_updated": "2024-12-18",
        "certification_date": "2024-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "77773-20",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100226310",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "svanrossum200552@ewd.direct.hshs.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "3021 Voyager Dr",
            "city": "Green Bay",
            "state": "WI",
            "country_code": "US",
            "postal_code": "543118303",
            "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.