NPIMap

Individual provider Active NPI

Evan M Krueger, DO

  • Neurological Surgery Physician
  • Neenah, WI
National Provider Identifier
1861807174
Registry record updated Apr 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
125065866 Issued in IL
Practice address
1305 W American Dr
Neenah, WI 54956-1993
Phone
(920) 729-7687
NPI assigned
Jun 25, 2014
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 23, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X 125065866 IL Primary
Neurological Surgery Physician 207T00000X 76808-21 WI

Addresses

Primary practice location

1305 W American Dr
Neenah, WI 54956-1993

Mailing address

1305 W American Dr
Neenah, WI 54956-1993

Other identifiers 1

IdentifierTypeStateIssuer
100206380MedicaidWI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ekrueger363014@ewd.direct.hshs.org Direct St Vincent Hospital-Hospital Sisters-Third Order of St Francis

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
I20220817002253 WI Practitioner - Neurosurgery 2264721067 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Neurosurgery
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Neuroscience Group of Northeast Wisconsin SCGroup PAC ID 6204740186, 57 clinicians

Practice addresses (Care Compare)

1305 W American Dr
Neenah, WI 54956-1993
Phone (800) 201-1194

1821 S Webster Ave
Green Bay, WI 54301-2253
Phone (920) 496-4700

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion64
Laminectomy or laminotomy (partial removal of spine bones)21

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
St Nicholas Hospital-Sisters of the Third Order of St Francis CurrentSince Aug 1, 2022 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis CurrentSince Aug 1, 2022 Accepting new patients
The Neuroscience Group of Northeast Wisconsin SC Neurological Surgery CurrentSince Aug 1, 2022 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis CurrentSince Aug 1, 2022 Accepting new patients
St. Nicholas Hospital-Sisters of the Third Order of St Francis Current Accepting new patients
St Clare Memorial Hospital, Inc CurrentSince Aug 1, 2022 Accepting new patients
St. Clare Memorial Hospital, Inc CurrentSince Aug 1, 2022 Accepting new patients
St Nicholas Hospital-Sisters of the Third Order of St Francis CurrentSince Aug 1, 2022 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis Past Accepting new patients

Locations

1821 S Webster Ave
Green Bay, WI 54301
Phone (920) 431-1850

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

1305 West American Dr
Neenah, WI 54956
Phone (920) 729-7687

130 2nd St
Neenah, WI 54956
Phone (920) 729-2063

855 S Main St
Ste 1
Oconto Falls, WI 54154
Phone (920) 846-8187

2700 W 9th Ave
Oshkosh, WI 54904
Phone (920) 223-0220

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

Organizations & group practices 9

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 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1403654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713830400000",
    "number": "1861807174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1305 W AMERICAN DR",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549561993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1305 W AMERICAN DR",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549561993",
            "telephone_number": "920-729-7687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRUEGER",
        "first_name": "EVAN",
        "middle_name": "M",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-06-25",
        "last_updated": "2024-04-23",
        "certification_date": "2024-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "IL",
            "license": "125065866",
            "primary": true
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "WI",
            "license": "76808-21",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100206380",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ekrueger363014@ewd.direct.hshs.org",
            "affiliation": "Y",
            "affiliationName": "St Vincent Hospital-Hospital Sisters-Third Order of St Francis",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "1821 S Webster Ave",
            "city": "Green Bay",
            "state": "WI",
            "country_code": "US",
            "postal_code": "543012253",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Neenah, WI

Sources for this page

Verify at the official NPI Registry.