Individual provider Active NPI

Victoria Passov, MD

  • Psychiatry Physician
  • Green Bay, WI
National Provider Identifier
1891838173
Registry record updated Nov 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
59847-20 Issued in WI
Practice address
301 E Saint Joseph St
Green Bay, WI 54301-2241
Phone
(920) 433-6073
Fax
(920) 431-0333
NPI assigned
Feb 15, 2007
Last updated
Nov 23, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 49830 MN
Psychiatry Physician 2084P0800X 59847-20 WI Primary

Addresses

Primary practice location

301 E Saint Joseph St
Green Bay, WI 54301-2241

Mailing address

PO Box 22040
Green Bay, WI 54305-2040
Phone (920) 445-7222

Other practice location 1

200 1st St SW
Rochester, MN 55905-0001
Phone (507) 284-2511

Other identifiers 1

IdentifierTypeStateIssuer
043445000MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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 1

Enrollment IDStateProvider typePAC IDDetails
I20130221000428 WI Practitioner - Psychiatry 1052406717 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bellin Memorial Hospital IncGroup PAC ID 8820900749, 685 clinicians

Practice addresses (Care Compare)

744 S Webster Ave
Green Bay, WI 54301-3505
Phone (920) 433-6025

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
49830MNMDPsychiatry Physician
59847-20WIMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bellin Memorial Hospital Inc CurrentSince May 1, 2019 Accepting new patients
Bellin Psychiatric Center Inc Psychiatry CurrentSince Nov 1, 2018 Accepting new patients
Bellin Memorial Hospital Inc CurrentSince May 1, 2019 Accepting new patients
Bellin Psychiatric Center Inc. CurrentSince Nov 1, 2018 Accepting new patients
Bellin Memorial Hospital Inc Current Accepting new patients
SBH-Green Bay LLC Psychiatry CurrentSince Oct 10, 2018 Accepting new patients
Bellin Psychiatric Center Inc Psychiatry Current Accepting new patients
Mayo Clinic Past Accepting new patients

Locations

1351 Ontario Rd
Green Bay, WI 54311
Phone (920) 328-1220

2305 San Luis Pl
Green Bay, WI 54304
Phone (920) 494-2817

301 Saint Joseph St
Green Bay, WI 54301
Phone (920) 430-3630

744 S Webster Ave
Green Bay, WI 54301
Phone (920) 433-6025

Interoperability endpoints

  • Direct secure messaging: vpassov201356@direct.thedacare.org
  • Direct secure messaging: vpassovadams925129@direct.emplifyhealth.org

Organizations & group practices 8

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.

Hospital & facility affiliations 1

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": "1171497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606089600000",
    "number": "1891838173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22040",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543052040",
            "telephone_number": "920-445-7222",
            "fax_number": "920-445-7229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 E SAINT JOSEPH ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543012241",
            "telephone_number": "920-433-6073",
            "fax_number": "920-431-0333"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 1st St SW",
            "address_purpose": "LOCATION",
            "city": "Rochester",
            "state": "MN",
            "postal_code": "559050001",
            "country_code": "US",
            "telephone_number": "507-284-2511",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PASSOV",
        "first_name": "VICTORIA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-15",
        "last_updated": "2020-11-23",
        "certification_date": "2020-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MN",
            "license": "49830",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WI",
            "license": "59847-20",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "043445000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.