PAUL M PRITCHARD MD
NPI 1790718922
Internal Medicine in Green Bay, WI


Quality Rating: 96.2 out of 100 score

NPI Status: Active since July 09, 2006

Contact Information

3021 VOYAGER DR
GREEN BAY, WI
ZIP 54311
Phone: (920) 496-4700
Fax: (920) 431-1995

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  • Individual
  • Male
  • Years of Experience 30
  • Internal Medicine
  • Accepts Insurance
  • Accepts Medicare Approved Payment
  • PECOS Enrolled

About PAUL PRITCHARD

This page provides the complete NPI Profile along with additional information for Paul Pritchard, an internist established in Green Bay, Wisconsin with a medical specialization in Internal Medicine and more than 30 years of experience. He graduated from Medical College Of Wisconsin in 1996. The healthcare provider is registered in the NPI registry with number 1790718922 assigned on July 2006. The practitioner's primary taxonomy code is 207R00000X with license number 39134 (WI). The provider is registered as an individual and his NPI record was last updated 17 years ago.

NPI
1790718922
Provider Name
PAUL M PRITCHARD MD
Gender
Male
Entity Type
Individual
Location Address
3021 VOYAGER DR GREEN BAY, WI 54311
Location Phone
(920) 496-4700
Location Fax
(920) 431-1995
Mailing Address
PO BOX 19070 PREVEA HEALTH GREEN BAY, WI 54307
Mailing Phone
(920) 496-4700
Mailing Fax
(920) 431-1995
Medical School Name
MEDICAL COLLEGE OF WISCONSIN
Graduation Year
1996
Is Sole Proprietor?
No
Enumeration Date
07-09-2006
Last Update Date
07-21-2008
Code Navigator

An internist like Paul Pritchard is a physician who has completed an internal medicine residency and is board-certified or board-eligible in an internist specialty. Internists are trained to care for adults of all ages for many different medical conditions. An internist typically monitors chronic physical conditions, identifies acute diseases, provides family planning, provides counseling about wellness and disease prevention, etc.

Location Map

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Internal Medicine

Taxonomy Code
207R00000X
Type
Allopathic & Osteopathic Physicians
License No.
39134
License State
WI
Taxonomy Description
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

  • Anthem Bronze Preferred/Broad 5000 (3 Free PCP Visits + $0 Select Drugs + Incentives) - POS
  • Anthem Bronze Preferred/Broad HSA (+ Incentives) - POS
  • Anthem Bronze Preferred/Broad Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
  • Anthem Gold Preferred/Broad 1000 ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
  • Anthem Gold Preferred/Broad Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
  • Anthem Heart Healthy Bronze Preferred/Broad 0 Med Ded ($0 Virtual PCP+$0 Select Drugs+Incentives) - POS
  • Anthem Silver Preferred/Broad 4000 (3 Free PCP Visits + $0 Select Drugs + Incentives) - POS
  • Anthem Silver Preferred/Broad 5300 (3 Free PCP Visits + $0 Select Drugs + Incentives) - POS
  • Anthem Silver Preferred/Broad Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
  • Chorus Bronze Complete - EPO
  • Chorus Bronze HDHP - EPO
  • Chorus Catastrophic - EPO
  • Chorus Core Bronze - EPO
  • Chorus Core Gold - EPO
  • Chorus Core Silver - EPO
  • Chorus Elite Gold - EPO
  • Chorus Gold - EPO
  • Chorus Silver - EPO
  • Chorus Silver Select - EPO
  • Prevea360 Bronze HSA - HMO
  • Prevea360 Bronze Share - HMO
  • Prevea360 Catastrophic - HMO
  • Prevea360 Expanded Bronze Standard - HMO
  • Prevea360 Gold HSA - HMO
  • Prevea360 Gold Share - HMO
  • Prevea360 Gold Standard - HMO
  • Prevea360 Silver $0 Copay PCP Visits - HMO
  • Prevea360 Silver Share - HMO
  • Prevea360 Silver Standard - HMO
  • Gold 1 - HMO
  • Gold 1 with Adult Vision Services - HMO
  • Gold 8 - HMO
  • Silver 1 - HMO
  • Silver 1 with Adult Vision Services - HMO
  • Silver 12 with First 4 Primary Care Visits Free - HMO
  • Silver 8 - HMO
  • Prestige Bronze Essential + 3 Free PCP Visits - HMO
  • Prestige Bronze Essential + Dental + Vision + 3 Free PCP Visits - HMO
  • Prestige Bronze Plus - HMO
  • Prestige Gold - HMO
  • Prestige Gold 50 + 1 Free PCP Visit - HMO
  • Prestige Gold 50 + Dental + Vision + 1 Free PCP Visit - HMO
  • Prestige Gold Essential + 3Free PCP Visits - HMO
  • Prestige Gold Essential + Dental + Vision + 3 Free PCP Visits - HMO
  • Prestige Silver - HMO
  • Prestige Silver Essential + 3 Free PCP Visits - HMO

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Additional Identifiers

The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State Identifier Issuer
G91964MEDICARE UPIN (02) 
32551400MEDICAID (05)WI 
07125-0167MEDICARE ID-TYPE UNSPECIFIED (04) 

Medicare Participation & PECOS Enrollment Status

Paul Pritchard is registered with Medicare and accepts claims assignment, this means the provider accepts the approved amount for the cost of rendered services as full payment. Participating providers may not charge beneficiaries more than the approved amount for their services. Please keep in mind that beneficiaries still have to pay a coinsurance or copayment amount for a visit or service.

Paul Pritchard is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.

What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.

  • Is the provider registered in PECOS? Yes

  • PECOS PAC ID: 1355497181

    What is the PECOS Associate Control ID?
    A PAC ID is a unique 10-digit number assigned to an individual or organization healthcare provider in PECOS. The PAC ID is used to link together all the provider information, like tax identification numbers and organizational names. A PAC ID can be connected to multiple Enrollment IDs if an individual or organization has enrolled in PECOS more than once.

  • PECOS Enrollment ID: I20090921000507

    What is the Provider Enrollment ID?
    The Enrollment ID is a unique alphanumeric 15-digit code assigned to each new provider's PECOS enrollment application. The Enrollment ID is used to link together all the provider enrollment information like enrollment type, state, provider specialty, and reassignment of benefits.

  • Accepts Medicare Assignment? Yes

    What does it mean "accepts medicare assignment"?
    When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts.
    A provider who doesn't accept assignment may charge you up to 15% over the Medicare-approved amount. This is known as the limiting charge. You may have to pay this amount, or it may be covered by another insurer.

  • Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes

  • Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes

  • Eligible to Order or Refer a Home Health Agency (HHA): Yes

  • Eligible to Order or Refer Power Mobility Devices: Yes

Provider Referred Orders for Durable Medical Equipment, Devices & Supplies

The following list reflects the services, supplies or durable medical equipment ordered by this provider to a DME supplier on behalf of patients. The information below is derived from Medicare claims data and reflects the BETOS category, HCPCS code information and the number times each service was submitted under the Medicare fee-for-service program.

Drugs Administered Through DME

  • DME-Drugs Administered Through DME (DG000N)

    Dornase alfa, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram (HCPCS:J7639)

    2 DME suppliers used 18 Medicare Claims 1350 Services Paid

Durable Medical Equipment

  • DME-Other DME (DE000N)

    Pharmacy dispensing fee for inhalation drug(s); per 30 days (HCPCS:Q0513)

    2 DME suppliers used 18 Medicare Claims 18 Services Paid

Areas of Expertise

The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.

Administration of influenza virus vaccine

The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.

This service was performed 115 times for 115 patients

Blood test, comprehensive group of blood chemicals

A comprehensive group of blood chemicals test, also known as a comprehensive metabolic panel, is a blood test that measures your sugar level, electrolyte and fluid balance, kidney function, and liver function. This helps to check your body's overall health.

This service was performed 16 times for 14 patients

Blood test, lipids (cholesterol and triglycerides)

A lipid panel is a blood test that measures fats and fatty substances, such as cholesterol and triglycerides. These substances are used by your body as a source of energy. High levels can lead to health issues, including heart disease.

This service was performed 13 times for 12 patients

Established patient office or other outpatient visit, 30-39 minutes

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

This service was performed 13 times for 12 patients

Influenza vaccine split virus, preservative free

The Influenza Vaccine Split Virus, preservative-free, is a flu shot to protect against the influenza virus. It is made from parts of inactivated flu viruses and doesn't contain preservatives, reducing potential side effects. It helps your body develop immunity to the flu.

This service was performed 99 times for 99 patients

Influenza vaccine, quadrivalent, preservative free, 0.5 ml dosage

The quadrivalent influenza vaccine is a shot to protect you from four different flu viruses. It's preservative-free and given in a 0.5 ml dose. It helps your body build immunity to the flu, reducing your risk of getting sick.

This service was performed 16 times for 16 patients

Insertion of needle into vein for collection of blood sample

This procedure involves inserting a small needle into a vein, typically in your arm, to collect a blood sample. It's a quick and simple process to help diagnose or monitor health conditions. You may feel a small prick, but discomfort is minimal.

This service was performed 21 times for 18 patients

Physician Visit Costs



The typical physician office visit costs for Medicare beneficiaries in this area are: $30.92 for a new patient copayment and $23.85 for an established patient copayment.

The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.

For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.

The prices below reflect the costs for new and established patients in the 54311 ZIP code area.

New Patients Visit Costs *

The most utilized procedure code for new patients office visits is 99204

  • Average New Patient Price $123.69
  • Minimum New Patient Price $53.9
  • Maximum New Patient Price $163.24
  • Average New Patient Copayment $30.92
  • Minimum New Patient Copayment $13.47
  • Maximum New Patient Copayment $40.81

Established Patients Visit Costs *

The most utilized procedure code for established patients office visits is 99214

  • Average Established Patient Price $95.41
  • Minimum Established Patient Price $17.4
  • Maximum Established Patient Price $133.76
  • Average Established Patient Copayment $23.85
  • Minimum Established Patient Copayment $4.35
  • Maximum Established Patient Copayment $33.44

* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.

Overall MIPS Quality Performance

The provider participated in CMS Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 96.2, based on four performance areas: quality, improvement activities, promoting interoperability, and cost. The purpose of this information is to help people with Medicare make informed decisions and incentivize doctors and clinicians to maximize performance.

The Merit-based Incentive Payment System (MIPS) is a way providers could use to participate in CMS Quality Payment Program (QPP). The MIPS program affects clinician reimbursement for Part B covered professional services and also rewards them for improving the quality of patient care and outcomes.

  • Final Score: 96.2 out of 100

    The MIPS program evaluates providers across multiple categories with a specific weight for each category resulting a in a MIPS final score that ranges from 0 to 100 points. The MIPS Final Score determines whether providers receive a negative, neutral or positive MIPS payment adjustment.

  • Quality Score: 85.8

    The Quality category assesses providers performance on clinical practices and patient outcomes under the traditional MIPS program. The quality measures help identify the quality of healthcare processes, outcomes, and patient experiences. The Quality measure category compromises 40% providers final MPIS scores.

    There are six collection types for MIPS quality measures: Electronic Clinical Quality Measures (eCQMs), MIPS Clinical Quality Measures (CQMs), Qualified Clinical Data Registry (QCDR) Measures, Medicare Part B claims measures, CMS Web Interface measures and The Consumer Assessment of Healthcare Providers and Systems (CAHPS) for MIPS Survey.

  • Promoting Interoperability Score: 100

    The Interoperability category measures the providers ability to use technology to exchange and make use of healthcare information in a way that is less burdensome and improves outcomes. The Interoperability measure category compromises 25% providers final MPIS scores.

    The MIPS Interoperability measure focuses on the use of certified electronic health record technology (CEHRT) to improve patient access health information, the exchange of information between clinicians and pharmacies and the systematic collection, analysis, and interpretation of healthcare data.

  • Improvement Activities Score: 40

    The Improvement Activities performance category evaluates the providers participation in clinical activities that support the improvement of clinical practice, care delivery, and outcomes. Providers have the option to choose 2 to 4 activities from an inventory of over 100 improvement activities. Providers typically choose the activities that best fit their needs. The improvement activities measure category compromises 15% providers final MPIS scores.

    The Improvement measures aim to better patient engagement, patient safety and other areas of patient care. The Improvement Activities category compromises 15% of providers final MPIS scores.

  • Cost Score: N/A

    The Cost performance category asses the amount and types of services provided and how clinicians coordinate care and seek improvement of health outcomes by ensuring patients receive the appropriate services.

    Although providers don't determine the price of healthcare services they are important in delivering high-quality care at a reasonable cost. The Cost measures category compromises 20% of providers final MPIS scores.

  • Cost Score: N/A

    The Cost performance category asses the amount and types of services provided and how clinicians coordinate care and seek improvement of health outcomes by ensuring patients receive the appropriate services.

    Although providers don't determine the price of healthcare services they are important in delivering high-quality care at a reasonable cost. The Cost measures category compromises 20% of providers final MPIS scores.

Find Provider Hospital Affiliations - Privileges

Doctors and physicians must apply for hospital privileges to treat patients at hospitals. Find out if your doctor has privileges to practice at your preferred hospital by using the hospital affiliation information below based on recent medical claims.

Hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the medical claims NPI number and place of service code. Additionally, to further determine provider hospital affiliation the clinician must have provided services to at least three patients on three different dates in the last 12 months. Paul Pritchard is affiliated with the following medical facilities:

Hospital Name Address Phone Hospital Type Overall Rating
ST VINCENT HOSPITAL835 S VAN BUREN ST
GREEN BAY, WI 54301
(920) 433-0111Acute Care Hospitals

Reviews for PAUL M PRITCHARD MD

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NPI Validation Check Digit Calculation


The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1790718922
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
271801411694
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 7 + 1 + 8 + 0 + 1 + 4 + 1 + 1 + 6 + 9 + 4 + 24 = 68
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
70 - 68 = 22

The NPI number 1790718922 is valid because the calculated check digit 2 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following 20 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1699747105 AL BALTRUSAITIS D.O.
Individual
Preventive Medicine (Preventive Medicine/Occupational Environmental Medicine)3021 VOYAGER DR
GREEN BAY, WI 54311
(920) 496-4700
1700819042 JESSE ISOBEL LEAHY MD
Individual
Family Medicine3021 VOYAGER DR
GREEN BAY, WI 54311
(920) 496-4700
1528083425 MICHELLE M CULLEN APNP
Individual
Registered Nurse3021 VOYAGER DR
GREEN BAY, WI 54311
(920) 496-4700
1770509580 DAVID RALPH KEIM MD
Individual
Pediatrics (Pediatric Rheumatology)3021 VOYAGER DR
GREEN BAY, WI 54311
(920) 496-4700
1346267929 DANIEL JOSEPH RIPP MD
Individual
Internal Medicine3021 VOYAGER DR
GREEN BAY, WI 54311
(920) 496-4700
1518984111 BROCK LYNDSEY ROBINSON MD
Individual
Physical Medicine & Rehabilitation3021 VOYAGER DR
GREEN BAY, WI 54311
(920) 496-4700
1245258581 PAUL JEROME SCHMITZ MD
Individual
Internal Medicine3021 VOYAGER DR
GREEN BAY, WI 54311
(920) 496-4700
1508885195 MARK KURT VILLWOCK MD
Individual
Family Medicine3021 VOYAGER DR
GREEN BAY, WI 54311
(920) 496-4700
1770505802 CHERYL ANNE WEIRAUCH APNP
Individual
Registered Nurse3021 VOYAGER DR
GREEN BAY, WI 54311
(920) 496-4700
1467475574 BARBARA J KOCH APNP
Individual
Registered Nurse3021 VOYAGER DR
GREEN BAY, WI 54311
(920) 496-4700
1912921636 LYNNE P STEENO APNP
Individual
Registered Nurse3021 VOYAGER DR
GREEN BAY, WI 54311
(920) 496-4700
1407860521 DANIEL BOWMAN PT
Individual
Physical Therapist3021 VOYAGER DR
GREEN BAY, WI 54311
(920) 496-4700
1801810460 BARBARA MAHLIK PT
Individual
Physical Therapist3021 VOYAGER DR
GREEN BAY, WI 54311
(920) 496-4700
1982618997 CHRISTOPHER SMITH OT
Individual
Occupational Therapist3021 VOYAGER DR
GREEN BAY, WI 54311
(920) 496-4700
1487678975 TONY PLESHE PT
Individual
Physical Therapist3021 VOYAGER DR
GREEN BAY, WI 54311
(920) 496-4700
1952315061 JENIFER NAGEL OT
Individual
Occupational Therapist3021 VOYAGER DR
GREEN BAY, WI 54311
(920) 496-4700
1497952410 YVONNE T NELSON APNP
Individual
Nurse Practitioner (Occupational Health)3021 VOYAGER DR
GREEN BAY, WI 54311
(920) 496-4700
1730405028 SHELLY NELL PTA
Individual
Physical Therapy Assistant3021 VOYAGER DR
GREEN BAY, WI 54311
(920) 496-4700
1912223207 DEANNE JADIN PTA
Individual
Physical Therapy Assistant3021 VOYAGER DR
GREEN BAY, WI 54311
(920) 496-4700
1285950576 JAMIE VANDENHOUTEN PTA
Individual
Physical Therapy Assistant3021 VOYAGER DR
GREEN BAY, WI 54311
(920) 496-4700

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1790718922, enumerated in the NPI registry as an "individual" on July 09, 2006

The provider is located at 3021 Voyager Dr Green Bay, Wi 54311 and the phone number is (920) 496-4700

The provider's speciality is Internal Medicine with taxonomy code 207R00000X

The provider has more than 30 years of experience. He graduated from Medical College Of Wisconsin in 1996.

The provider might be accepting Accepts: Anthem Blue Cross and Blue Shield, Chorus. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.

Yes, as of June 20, 2025 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a beneficiary the provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.

The provider has an overall high rating in the following quality measures: quality clinical practices and patient outcomes and experiences , uses technology to exchange and make use of healthcare information.

Medicare beneficiaries should expect a typical cost of $123.69 with an average copayment of $30.92 for new patient appointments. Established patients should expect a typical charge of $95.41 and an average copayment of 23.85. Please review your insurance plan or contact the provider directly to determine your specific costs.

The most common procedures or services performed by this practitioner are: Administration of influenza virus vaccine, Blood test, comprehensive group of blood chemicals, Blood test, lipids (cholesterol and triglycerides), Established patient office or other outpatient visit, 30-39 minutes, Influenza vaccine split virus, preservative free, Influenza vaccine, quadrivalent, preservative free, 0.5 ml dosage and Insertion of needle into vein for collection of blood sample.

The practitioner is affiliated to the following hospital(s): ST VINCENT HOSPITAL. Hospital affiliations are identified through self-reporting data and service claims based on the place of service.

This NPI record was last updated on July 09, 2006. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
NPI Profile data is regularly updated with the latest NPI registry information, if you would like to update or remove your NPI Profile in this website please contact us.