Organization Active NPI

Customized Health Care Services, LLC

  • Internal Medicine Physician
  • Green Bay, WI
National Provider Identifier
1962347641
Registry record updated Apr 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
CUSTOMIZED HEALTH CARE SERVICES, LLC
Practice address
108 Packerland Dr Ste D1
Green Bay, WI 54303-4862
Phone
(920) 545-5109
Fax
(920) 593-9159
NPI assigned
Apr 21, 2026
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2026

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

Authorized official

Name
Brian Woodbridge, MDNPI 1720055817
Title
Owner
Phone
(920) 545-5109

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

108 Packerland Dr Ste D1
Green Bay, WI 54303-4862

Mailing address

108 Packerland Dr Ste D1
Green Bay, WI 54303-4862
Phone (920) 545-5109

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260602003916 WI Part B Supplier - Clinic/Group Practice 9537630348 Receives reassigned benefits from 3 practitioners
Practice locations: Green Bay, WI; Luxemburg, WI; Two Rivers, WI

National Provider Directory

National Provider Directory

Locations

2848 Memorial Dr
Ste A
Two Rivers, WI 54241

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1776729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776729600000",
    "number": "1962347641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 PACKERLAND DR STE D1",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543034862",
            "telephone_number": "920-545-5109",
            "fax_number": "920-593-9159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 PACKERLAND DR STE D1",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543034862",
            "telephone_number": "920-545-5109",
            "fax_number": "920-593-9159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUSTOMIZED HEALTH CARE SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-04-21",
        "last_updated": "2026-04-21",
        "certification_date": "2026-04-21",
        "status": "A",
        "authorized_official_last_name": "WOODBRIDGE",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "920-545-5109",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.