NPIMap

Individual provider Active NPI

Lynnette Leona Clancy, APNP

  • Family Nurse Practitioner
  • Green Bay, WI
National Provider Identifier
1972528925
Registry record updated Sep 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
1390 Issued in WI
Practice address
1715 Dousman St
Green Bay, WI 54303-3211
Phone
(920) 496-4700
Fax
(920) 496-4705
NPI assigned
Jul 12, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2016

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 130862 WI
Family Nurse Practitioner 363LF0000X 1390 WI Primary

Addresses

Primary practice location

1715 Dousman St
Green Bay, WI 54303-3211

Mailing address

PO Box 19070
Prevea Health
Green Bay, WI 54307-9070
Phone (920) 496-4700

Other identifiers 1

IdentifierTypeStateIssuer
43902300MedicaidWI

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
I20071011000645 WI Practitioner - Nurse Practitioner 4385730969 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1860 Shawano Ave
Green Bay, WI 54303-2667
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
1390WIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Prevea Clinic, Inc. CurrentSince Oct 26, 1998 Accepting new patients
Prevea Clinic, Inc. CurrentSince Oct 26, 1998 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis Current Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis CurrentSince Aug 1, 2009 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis CurrentSince Aug 1, 2009 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis Past Accepting new patients
Prevea Regional Services, Inc. Past 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

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

1715 Dousman St
Green Bay, WI 54303

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473897600000",
    "number": "1972528925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19070",
            "address_2": "PREVEA HEALTH",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543079070",
            "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",
            "fax_number": "920-496-4705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLANCY",
        "first_name": "LYNNETTE",
        "middle_name": "LEONA",
        "credential": "APNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-12",
        "last_updated": "2016-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WI",
            "license": "130862",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "1390",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43902300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.