Organization Active NPI

Bellin Memorial Hospital Inc

Doing business as FMC Brillion

  • Family Medicine Physician
  • Brillion, WI
National Provider Identifier
1962464784
Registry record updated May 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
BELLIN MEMORIAL HOSPITAL INC
Doing business as
FMC Brillion
Practice address
235 E Ryan St
Brillion, WI 54110-1132
Phone
(920) 756-2055
Fax
(920) 756-3350
NPI assigned
Apr 5, 2006
Last updated
May 28, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
BELLIN MEMORIAL HOSPITAL INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 28, 2025

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

Authorized official

Name
Abby Julia Engebose
Title
Credentialing Specialist
Phone
(920) 433-7860

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

235 E Ryan St
Brillion, WI 54110-1132

Mailing address

235 E Ryan St
Brillion, WI 54110-1132
Phone (920) 756-2055

Other names 1

  • FMC BRILLION Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031121000089 WI Part B Supplier - Clinic/Group Practice 8820900749 Receives reassigned benefits from 936 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Part of
Bellin Memorial Hospita

Locations (25 of 31)

106 S School Rd
Daggett, MI 49821
Phone (906) 753-2155

1711 S Stephenson Ave
Ste 115
Iron Mountain, MI 49801
Phone (906) 774-6186

1721 S Stephenson Ave
Ste 215
Iron Mountain, MI 49801

212 E B St
Ste 212
Iron Mountain, MI 49801

901 Pyle Dr
Kingsford, MI 49802
Phone (906) 774-3779

100 Grant St
De Pere, WI 54115
Phone (708) 710-7696

1241 Lombardi Access Rd
Green Bay, WI 54304
Phone (920) 431-7120

1580 Commanche Ave
Green Bay, WI 54313
Phone (920) 431-5687

301 Bay Park Sq
Green Bay, WI 54304
Phone (920) 499-3511

3263 Eaton Rd
Ste 1
Green Bay, WI 54311
Phone (920) 433-6000

704 S Webster Ave
#100A
Green Bay, WI 54301

704 S Webster Ave
Fl 2
Green Bay, WI 54301

704 S Webster Ave
Ste 100B
Green Bay, WI 54301
Phone (920) 433-3496

704 S Webster Ave
Ste 200
Green Bay, WI 54301
Phone (920) 433-3456

704 S Webster Ave
Ste 300
Green Bay, WI 54301
Phone (920) 468-3443

720 S Van Buren St
Ste 104
Green Bay, WI 54301
Phone (920) 433-7471

725 S Webster Ave
Green Bay, WI 54301
Phone (920) 433-7995

725 S Webster Ave
Ste 303
Green Bay, WI 54301
Phone (920) 431-5650

744 S Webster Ave
#2
Green Bay, WI 54301

744 S Webster Ave
Fl 7
Green Bay, WI 54301

774 S Webster Ave
Green Bay, WI 54301

1304 1st St
Kewaunee, WI 54216

15481 Commercial Rd
Ste E
Lakewood, WI 54138
Phone (715) 276-9048

3415 Custer St
Manitowoc, WI 54220
Phone (920) 652-2440

3130 Shore Dr
Ste 104
Marinette, WI 54143
Phone 71573542004500

Practitioners & affiliated clinicians

Practitioners 460

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 460

NPI Registry JSON

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

{
    "created_epoch": "1144195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748390400000",
    "number": "1962464784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 E RYAN ST",
            "city": "BRILLION",
            "state": "WI",
            "postal_code": "541101132",
            "telephone_number": "920-756-2055",
            "fax_number": "920-756-3350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 E RYAN ST",
            "city": "BRILLION",
            "state": "WI",
            "postal_code": "541101132",
            "telephone_number": "920-756-2055",
            "fax_number": "920-756-3350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BELLIN MEMORIAL HOSPITAL INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BELLIN MEMORIAL HOSPITAL INC",
        "enumeration_date": "2006-04-05",
        "last_updated": "2025-05-28",
        "certification_date": "2025-05-28",
        "status": "A",
        "authorized_official_last_name": "ENGEBOSE",
        "authorized_official_first_name": "ABBY",
        "authorized_official_middle_name": "JULIA",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "920-433-7860"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FMC BRILLION",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "FMC BRILLION",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brillion, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2025; 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.