NPIMap

Individual provider Active NPI

Katrina Severance, DO

  • Family Medicine Physician
  • Green Bay, WI
National Provider Identifier
1952599763
Registry record updated Aug 27, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
61980-021 Issued in WI
Practice address
2793 Lineville Rd
Green Bay, WI 54313-7152
Phone
(920) 496-4700
NPI assigned
Oct 5, 2007
Last updated
Aug 27, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2014

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 5101017261 MI
Family Medicine Physician 207Q00000X 61980-021 WI Primary
Family Medicine Physician 207Q00000X 02004223A IN

Addresses

Primary practice location

2793 Lineville Rd
Green Bay, WI 54313-7152

Mailing address

2793 Lineville Rd
Green Bay, WI 54313-7152
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
I20141205001682 WI Practitioner - Family Practice 2860689536 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2793 Lineville Rd
Green Bay, WI 54313-7152
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
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
61980-021WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis CurrentSince Aug 25, 2014 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis CurrentSince Aug 25, 2014 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis Family Medicine Current Accepting new patients
Prevea Clinic, Inc. Family Medicine Current Accepting new patients
Prevea Clinic, Inc. Family Medicine CurrentSince Jul 3, 2018 Accepting new patients

Locations

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

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

2793 Lineville Rd
Howard, WI 54313

Organizations & group practices 5

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 7

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": "1191542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1409097600000",
    "number": "1952599763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2793 LINEVILLE RD",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543137152",
            "telephone_number": "920-496-4700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2793 LINEVILLE RD",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543137152",
            "telephone_number": "920-496-4700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEVERANCE",
        "first_name": "KATRINA",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-05",
        "last_updated": "2014-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101017261",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "61980-021",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "02004223A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.