Active NPI
Benjamin Buckoski, CCP
- Perfusionist
- Green Bay, WI
National Provider Identifier
1982137253
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Perfusionist
- License
- 173
- Practice address
- 2845 Greenbrier Rd
Green Bay, WI 54311-6519 - Phone
- (920) 288-8320
- NPI assigned
- Apr 4, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Perfusionist | 242T00000X | 173 | WI | Primary |
Addresses
Primary practice location
2845 Greenbrier Rd
Green Bay, WI 54311-6519
Mailing address
164 N Broadway
Green Bay, WI 54303-2728
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 173 | WI | MD | Perfusionist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1491264000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1491264000000",
"number": "1982137253",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "164 N BROADWAY",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543032728"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2845 GREENBRIER RD",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543116519",
"telephone_number": "920-288-8320"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUCKOSKI",
"first_name": "BENJAMIN",
"credential": "CCP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-04-04",
"last_updated": "2017-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "242T00000X",
"taxonomy_group": "",
"desc": "Perfusionist",
"state": "WI",
"license": "173",
"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 4, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.