NPIMap

Individual provider Active NPI

Richard J Horak, M.D.

  • Diagnostic Radiology Physician
  • Green Bay, WI
National Provider Identifier
1902092059
Registry record updated Mar 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
52540-020 Issued in WI
Practice address
1789 Shawano Ave
Green Bay, WI 54303-3243
Phone
(920) 499-1428
NPI assigned
Sep 22, 2007
Last updated
Mar 20, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 52540-020 WI Primary

Addresses

Primary practice location

1789 Shawano Ave
Green Bay, WI 54303-3243

Mailing address

1789 Shawano Ave
Green Bay, WI 54303-3243
Phone (920) 499-1428

Other identifiers 1

IdentifierTypeStateIssuer
100030163MedicaidWI

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
I20130726000675 WI Practitioner - Diagnostic Radiology 1052576139 Reassigns benefits to 2 organizations
I20181115002017 MI Practitioner - Diagnostic Radiology 1052576139 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Radiology CharteredGroup PAC ID 1557394988, 39 clinicians

Practice addresses (Care Compare)

Marquette, MI 49855
Phone (920) 499-2766

1789 Shawano Ave
Green Bay, WI 54303-3243
Phone (920) 499-1428

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
52540-020WIMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bellin Memorial Hospital Inc Diagnostic Radiology CurrentSince Jul 1, 2013 Accepting new patients
Bellin Memorial Hospital Inc Current Accepting new patients
Bellin Memorial Hospital Inc CurrentSince Jul 9, 2013 Accepting new patients
Bellin Memorial Hospital Inc Current Accepting new patients
Bellin Memorial Hospital Inc CurrentSince Apr 6, 2015 Accepting new patients
Radiology Chartered Diagnostic Radiology CurrentSince Jul 15, 2013 Accepting new patients
Bellin Memorial Hospital Inc. CurrentSince Jul 1, 2013 Accepting new patients

Locations

610 S Lincoln Rd
Escanaba, MI 49829
Phone (906) 786-6488

440 Woodward Ave
Iron Mountain, MI 49801
Phone (906) 776-9040

1789 Shawano Ave
Green Bay, WI 54303
Phone (920) 494-2310

740 S Van Buren St
Green Bay, WI 54301
Phone (920) 433-3411

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

2820 Roosevelt Rd
Marinette, WI 54143
Phone (715) 330-6171

820 Arbutus Ave
Oconto, WI 54153
Phone (920) 835-1100

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1190419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679270400000",
    "number": "1902092059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1789 SHAWANO AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543033243",
            "telephone_number": "920-499-1428",
            "fax_number": "920-499-7080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1789 SHAWANO AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543033243",
            "telephone_number": "920-499-1428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HORAK",
        "first_name": "RICHARD",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-09-22",
        "last_updated": "2023-03-20",
        "certification_date": "2023-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WI",
            "license": "52540-020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100030163",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.