Gordon Glenn Roedel, MD

Primary specialty

Adult Reconstructive Orthopaedic Surgery PhysicianTaxonomy code 207XS0114X

License

82150 Issued in WI

Practice address

2223 Lime Kiln Rd Ste 1
Green Bay, WI 54311-6213

Phone

(920) 430-8113

Fax

(920) 430-8122

NPI assigned

Jun 29, 2017

Last updated

Aug 18, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WV, WI2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Orthopedic Surgery

Education

University of Wisconsin School of Medicine, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Orthopedic and Sports Medicine Specialists of Green Bay SCGroup PAC ID 9739264714, 47 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Marys Hospital Medical Ctr Hospital, Green Bay, WI, CCN 520097
• Door County Medical Center Hospital, Sturgeon Bay, WI, CCN 521358
• Osf St Francis Hospital and Medical Group Hospital, Escanaba, MI, CCN 231337

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: groedel325854@direct.wvuhsdirect.com
• FHIR API: https://fhir-myrecord.cerner.com/r4/0cda6ed7-9e18-4112-ab11-d5a45a40c8d5/

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Orthopedic & Sports Medicine Specialists of Green Bay, SC

  • Specialist
  • Green Bay, WI
  • NPI 1760670145

  Orthopaedic Surgery

  Medicare reassignment Care Compare group NPD
• Orthopedic Surgery Center of Green Bay, LLC

  • Ambulatory Surgical Clinic/Center
  • Green Bay, WI
  • NPI 1922334101
  NPD (past)

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

• Door County Memorial Hospital

  dba Door County Medical Center

  • Critical Access Hospital
  • Sturgeon Bay, WI
  • NPI 1093743874
  Care Compare affiliation
• Door County Memorial Hospital

  dba Door County Medical Center Lab

  • Clinical Medical Laboratory
  • Sturgeon Bay, WI
  • NPI 1811090285

  Hospital

  Care Compare affiliation
• St Mary's Hospital Medical Center of Green Bay Inc.-Hospital Sisters

  • General Acute Care Hospital
  • Green Bay, WI
  • NPI 1649246877
  Care Compare affiliation
• St Francis Hospital

  dba OSF Healthcare St. Francis Hospital & Medical Group

  • Critical Access Hospital
  • Escanaba, MI
  • NPI 1922058551
  Care Compare affiliation

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

{
    "created_epoch": "1498694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692316800000",
    "number": "1851812937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2223 LIME KILN RD STE 1",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543116213",
            "telephone_number": "920-430-8113",
            "fax_number": "920-430-8122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2223 LIME KILN RD STE 1",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543116213",
            "telephone_number": "920-430-8113",
            "fax_number": "920-430-8122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROEDEL",
        "first_name": "GORDON",
        "middle_name": "GLENN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-29",
        "last_updated": "2023-08-18",
        "certification_date": "2023-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NE",
            "license": "8109",
            "primary": false
        },
        {
            "code": "207XS0114X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery",
            "state": "WI",
            "license": "82150",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Seniasor Rodriguez-Gomez, LPC-IT
• Angela Rodriguez
• Gabrielle Marie Rodriguez, PSY.D
• Jaylee M Rodriguez, RN
• Josefina Rodriguez, MD
• Judy Marie Roemer, L.P.C.
• Daniel J Roenz, PT
• Patrick E Rogers, CRNA
• Barbara Rohan, RPH
• David C Rohde, MD

• Adult Reconstructive Orthopaedic Surgery Physician in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Adult Reconstructive Orthopaedic Surgery Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.