NPIMap

Organization Active NPI

Hemophilia Outreach of Wisconsin, Inc.

  • Hematology (Internal Medicine) Physician
  • Green Bay, WI
National Provider Identifier
1851390686
Registry record updated Feb 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology (Internal Medicine) PhysicianTaxonomy code 207RH0000X
License
40681 Issued in WI
Legal business name
HEMOPHILIA OUTREACH OF WISCONSIN, INC.
Practice address
2060 Bellevue St
Green Bay, WI 54311-5622
Phone
(920) 965-0606
Fax
(920) 965-0607
NPI assigned
Jul 14, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2022

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

Authorized official

Name
Mr. Jamison Buxton
Title
Executive Director
Phone
(920) 965-0606

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology (Internal Medicine) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RH0000X 40681 WI Primary
Non-Pharmacy Dispensing Site 332900000X 5123170 WI

Addresses

Primary practice location

2060 Bellevue St
Green Bay, WI 54311-5622

Mailing address

2060 Bellevue St
Green Bay, WI 54311-5622
Phone (920) 965-0606

Other practice location 1

3550 Stewart Ave
Wausau, WI 54401-4919
Phone (715) 680-9810

Other identifiers 2

IdentifierTypeStateIssuer
5123170OtherWINCPDP NUMBER
32850600MedicaidWI

Other names 1

  • Hemophilia Outreach Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://home.hshs.org/SAAS/auth/login

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080130000138 WI Part B Supplier - Clinic/Group Practice 6507948593 Receives reassigned benefits from 7 practitioners
Practice locations: Green Bay, WI

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
52D2111433Hemophilia Outreach Center2060 Bellevue St, Green Bay, WI 54311Certificate of waiverApr 5, 2028

National Provider Directory

National Provider Directory

Locations

1794 Allouez Ave
Green Bay, WI 54311
Phone (920) 965-0606

2060 Bellevue St
Green Bay, WI 54311
Phone (920) 965-0606

3550 Stewart Ave
Wausau, WI 54401
Phone (715) 680-9810

Practitioners & affiliated clinicians

Practitioners 7

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

NPI Registry JSON

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

{
    "created_epoch": "1121299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643673600000",
    "number": "1851390686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2060 BELLEVUE ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543115622",
            "telephone_number": "920-965-0606",
            "fax_number": "920-965-0607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2060 BELLEVUE ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543115622",
            "telephone_number": "920-965-0606",
            "fax_number": "920-965-0607"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3550 Stewart Ave",
            "address_purpose": "LOCATION",
            "city": "Wausau",
            "state": "WI",
            "postal_code": "544014919",
            "country_code": "US",
            "telephone_number": "715-680-9810",
            "fax_number": "715-201-9170",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "HEMOPHILIA OUTREACH OF WISCONSIN, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-14",
        "last_updated": "2022-02-01",
        "certification_date": "2021-09-27",
        "status": "A",
        "authorized_official_last_name": "BUXTON",
        "authorized_official_first_name": "JAMISON",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "920-965-0606",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207RH0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Hematology",
            "state": "WI",
            "license": "40681",
            "primary": true
        },
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "WI",
            "license": "5123170",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP NUMBER",
            "identifier": "5123170",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32850600",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://home.hshs.org/SAAS/auth/login",
            "affiliation": "N",
            "address_1": "2060 Bellevue St",
            "city": "Green Bay",
            "state": "WI",
            "country_code": "US",
            "postal_code": "543115622",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Hemophilia Outreach Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Hemophilia Outreach Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Feb 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.