NPIMap

Individual provider Active NPI

Alex Coffman, MD

  • Radiation Oncology Physician
  • Green Bay, WI
National Provider Identifier
1871045690
Registry record updated Dec 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
License
75577-20 Issued in WI
Practice address
1726 Shawano Ave
Green Bay, WI 54303-3216
Phone
(920) 884-3135
NPI assigned
Oct 27, 2016
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 22, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Radiation Oncology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0001X 75577-20 WI Primary
Radiation Oncology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0001X 153028 CA

Addresses

Primary practice location

1726 Shawano Ave
Green Bay, WI 54303-3216

Mailing address

1726 Shawano Ave
Green Bay, WI 54303-3216
Phone (801) 971-8416

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address acoffman323642@ewd.direct.hshs.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, MI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210812002714 WI Practitioner - Radiation Oncology 0941604912 Reassigns benefits to 2 organizations
I20230503003009 MI Practitioner - Radiation Oncology 0941604912 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Radiation Oncology
Education
University of Vermont College of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

323 S 18TH Ave
Sturgeon Bay, WI 54235-1401
Phone (920) 884-3135

835 S Van Buren St
Green Bay, WI 54301-3526
Phone (920) 433-0111

850 W Baraga Ave
Marquette, MI 49855-4550
Phone (906) 449-3404

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
153028CAMDRadiation Oncology Physician
75577-20WIMDRadiation Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
DLP Marquette Physician Practices Inc CurrentSince Mar 1, 2023 Accepting new patients
St Mary'S Hospital Medical Center of Green Bay Inc.-Hospital Sisters Multi-Specialty CurrentSince Aug 1, 2021 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis Multi-Specialty CurrentSince Aug 1, 2021 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis Multi-Specialty Current Accepting new patients
DLP Marquette Physician Practices Inc Multi-Specialty CurrentSince Mar 1, 2023 Accepting new patients
St. Vincent Hospital-Hospital Sisters-Third Order of St. Francis Multi-Specialty CurrentSince Aug 1, 2021 Accepting new patients
DLP Marquette Physician Practices Inc Multi-Specialty Past Accepting new patients

Locations

850 W Baraga Ave
Marquette, MI 49855
Phone (906) 225-3595

850 W Baraga Ave
Ste 10
Marquette, MI 49855
Phone (906) 449-3894

1414 W Fair Ave
Ste 36
Marquette, MI 49855
Phone (906) 225-3864

330 Seven Springs Way
Brentwood, TN 37027
Phone (615) 920-7780

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

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

1621 N Taylor Dr
Sheboygan, WI 53081
Phone (920) 458-4419

Interoperability endpoints

  • Direct secure messaging: acoffman323642@ewd.direct.hshs.org

Organizations & group practices 7

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 9

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": "1477526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640131200000",
    "number": "1871045690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1726 SHAWANO AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543033216",
            "telephone_number": "801-971-8416"
        },
        {
            "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": "920-884-3135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COFFMAN",
        "first_name": "ALEX",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-10-27",
        "last_updated": "2021-12-22",
        "certification_date": "2021-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Radiation Oncology",
            "state": "WI",
            "license": "75577-20",
            "primary": true
        },
        {
            "code": "2085R0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Radiation Oncology",
            "state": "CA",
            "license": "153028",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "acoffman323642@ewd.direct.hshs.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "1726 Shawano Ave",
            "city": "Green Bay",
            "state": "WI",
            "country_code": "US",
            "postal_code": "543033216",
            "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.