NPIMap

Individual provider Active NPI

Robert Thomas Cutlan, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Green Bay, WI
National Provider Identifier
1821021239
Registry record updated Jul 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
44339 Issued in WI
Practice address
1726 Shawano Ave
Green Bay, WI 54303-3216
Phone
(920) 496-4700
Fax
(920) 884-3566
NPI assigned
Jul 9, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 44339 WI Primary

Addresses

Primary practice location

1726 Shawano Ave
Green Bay, WI 54303-3216

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
34290000MedicaidWI

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
I20070326000339 WI Practitioner - Pathology 4385748656 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Medical College of Wisconsin, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1726 Shawano Ave
Green Bay, WI 54303-3216
Phone (920) 496-4700

Hospital & facility affiliations

  • St Marys Hospital Medical Ctr Hospital, Green Bay, WI, CCN 520097
  • St Nicholas Hospital Hospital, Sheboygan, WI, CCN 520044
  • St Vincent Hospital Hospital, Green Bay, WI, CCN 520075
  • Bellin Memorial Hospital Hospital, Green Bay, WI, CCN 520049
  • HSHS St Clare Memorial Hospital Hospital, Oconto Falls, WI, CCN 521310

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
44339WIMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis CurrentSince Aug 1, 2009 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis CurrentSince Aug 1, 2009 Accepting new patients
Prevea Clinic, Inc. Anatomic Pathology & Clinical Pathology Past Accepting new patients
Prevea Regional Services, Inc. Past Accepting new patients
St Clare Memorial Hospital, Inc PastSince Sep 1, 2014 Accepting new patients

Locations

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

1715 Dousman St
Green Bay, WI 54303

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

620 Smith Ave
Oconto, WI 54153
Phone (920) 834-4110

515 E Mill St
Plymouth, WI 53073
Phone (920) 892-2395

Organizations & group practices 5

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 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216771200000",
    "number": "1821021239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19070",
            "address_2": "PREVEA HEALTH",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543079070",
            "telephone_number": "920-496-4700",
            "fax_number": "920-884-3566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1726 SHAWANO AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543033216",
            "telephone_number": "920-496-4700",
            "fax_number": "920-884-3566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CUTLAN",
        "first_name": "ROBERT",
        "middle_name": "THOMAS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-09",
        "last_updated": "2008-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "WI",
            "license": "44339",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34290000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.