NPIMap

Organization Active NPI

Medexpress Primary Care Wisconsin, S.C.

  • General Practice Physician
  • De Pere, WI
National Provider Identifier
1912650607
Registry record updated Feb 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
MEDEXPRESS PRIMARY CARE WISCONSIN, S.C.
Practice address
2020 Innovation CT
De Pere, WI 54115-6009
Phone
(920) 661-4215
Fax
(920) 661-4277
NPI assigned
Feb 2, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2022

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

Authorized official

Name
Brett Gall
Title
Director of Payor Contracting
Phone
(304) 225-2500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

2020 Innovation CT
De Pere, WI 54115-6009

Mailing address

1001 Consol Energy Dr
Canonsburg, PA 15317-6506
Phone (304) 225-2500

Other names 1

  • The Well - Green Bay Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Medexpress Primary Care Wisconsin SC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1643760000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643760000000",
    "number": "1912650607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 CONSOL ENERGY DR",
            "city": "CANONSBURG",
            "state": "PA",
            "postal_code": "153176506",
            "telephone_number": "304-225-2500",
            "fax_number": "724-743-1133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 INNOVATION CT",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541156009",
            "telephone_number": "920-661-4215",
            "fax_number": "920-661-4277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDEXPRESS PRIMARY CARE WISCONSIN, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-02",
        "last_updated": "2022-02-02",
        "certification_date": "2022-02-02",
        "status": "A",
        "authorized_official_last_name": "GALL",
        "authorized_official_first_name": "BRETT",
        "authorized_official_title_or_position": "DIRECTOR OF PAYOR CONTRACTING",
        "authorized_official_telephone_number": "304-225-2500"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Well - Green Bay",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in De Pere, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.