NPIMap

Individual provider Active NPI

Sally Beth Bowa, APNP

  • Nurse Practitioner
  • Green Bay, WI
National Provider Identifier
1932532991
Registry record updated Sep 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
5408-33 Issued in WI
Practice address
1715 Dousman St
Green Bay, WI 54303-3211
Phone
(920) 496-4700
NPI assigned
Aug 14, 2013
Last updated
Sep 4, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 163840-30 WI
Nurse Practitioner 363L00000X 5408-33 WI Primary

Addresses

Primary practice location

1715 Dousman St
Green Bay, WI 54303-3211

Mailing address

1715 Dousman St
Green Bay, WI 54303-3211
Phone (920) 496-4700

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
I20131024001979 WI Practitioner - Nurse Practitioner 2567697725 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

835 S Van Buren St
Green Bay, WI 54301-3526
Phone (920) 496-4700

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.81 of 100Reported as apm
Quality
85.98
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
163840-30WIMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis CurrentSince Sep 3, 2013 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis CurrentSince Sep 3, 2013 Accepting new patients

Locations

1715 Dousman St
Green Bay, WI 54303

1860 Shawano Ave
Green Bay, WI 54303
Phone (920) 405-1414

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

Organizations & group practices 2

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 12

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": "1376438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378252800000",
    "number": "1932532991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1715 DOUSMAN ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543033211",
            "telephone_number": "920-496-4700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1715 DOUSMAN ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543033211",
            "telephone_number": "920-496-4700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOWA",
        "first_name": "SALLY",
        "middle_name": "BETH",
        "credential": "APNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-14",
        "last_updated": "2013-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WI",
            "license": "163840-30",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "5408-33",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.