ANDREA JO POULSON-PORT M.D.
NPI 1326280611
Family Medicine in Manitowoc, WI

Q: What is Andrea Poulson-port's NPI number?

The NPI number for Andrea Poulson-port is 1326280611. It was assigned to this individual provider in the NPPES registry on April 1, 2009.

Q: What is Andrea Poulson-port's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Active since April 01, 2009PECOS Enrolled

4100 DEWEY ST, MANITOWOC, WI 54220(920) 686-5700 Get Directions Write a Review

NPPES record last updated: September 24, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Sep 24, 2024, Dec 1, 2021 (2 updates tracked since 2021).

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About Andrea Jo Poulson-port M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ANDREA JO POULSON-PORT M.D. (NPI 1326280611) is an individual family medicine provider in Manitowoc, Wisconsin, licensed in Wisconsin (56118-20) and active in the NPI registry since April 2009. She is enrolled in Medicare PECOS, is affiliated with Aurora Medical Ctr Manitowoc County, and is a graduate of Wayne State University School Of Medicine (2009).

NPPES Registry Identity

NPI1326280611

Entity TypeIndividualFemale

Primary Taxonomy207Q00000X

Provider Legal NameANDREA JO POULSON-PORTCredential: M.D.

Location Address4100 DEWEY STManitowoc, WI 54220-5497

Mailing AddressPo Box 735044Chicago, IL 60673-5044 · (800) 326-2250

Phone(920) 686-5700

Sole ProprietorNo

Medical School CMSWayne State University School Of MedicineGraduated 2009

Enumeration DateApril 1, 2009

Last NPPES UpdateSeptember 24, 20242 updates tracked since enumeration

NPPES CertifiedSeptember 24, 2024

✔ NPI 1326280611 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

License✔ Licensed in WI · 56118-20

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

4100 DEWEY ST, Manitowoc, WI 54220

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Other Identifiers 1

Medicaid100024879WI

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Aspirus Health Plan, CareSource (Common Ground Healthcare) and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Andrea Jo Poulson-port M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID8820247299

PECOS Enrollment IDI20120927000853

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

Medicare enrollment records show Andrea Poulson-port reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Aurora Medical Group, Inc.

22 mi

Clinic/Center

2414 KOHLER MEMORIAL DR
Sheboygan, WI 53081

Reassigned Medicare billing, Wisconsin enrollment
4,609 clinicians in this Medicare group

NPI 1174670244 (920) 457-4461

Aamg Reach PLLC

163 mi

Family Medicine

1357 W 103RD ST
Chicago, IL 60643

Reassigned Medicare billing, Wisconsin enrollment
41 clinicians in this Medicare group

NPI 1609502707 (773) 238-0800

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 10

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

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.

234 services146 patients

Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439

An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.

134 services134 patients

Anticoagulant management of patient taking warfarin 93793

Anticoagulant management with warfarin involves monitoring and adjusting your medication to prevent blood clots while minimizing the risk of bleeding. Regular blood tests measure your response to warfarin, helping adjust your dose if necessary. It's crucial to maintain a consistent diet and promptly report any changes in your health.

97 services48 patients

Administration of influenza virus vaccine G0008

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.

62 services62 patients

Influenza vaccine split virus, preservative free 90662

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.

53 services53 patients

Blood test, clotting time 85610

A clotting time blood test helps determine how quickly your blood forms clots, a process crucial to stop bleeding. During the test, a small blood sample is taken from your arm. The sample is then analyzed in a lab to see how long it takes for a clot to form.

51 services20 patients

Hospital Affiliations CMS Care Compare 2

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Aurora Medical Ctr Manitowoc County

Acute Care Hospitals · Two Rivers, WI

OwnershipVoluntary non-profit - Private

CMS Certification Number520034

Location5000 Memorial DriveTwo Rivers, WI 54241 · Manitowoc County

Emergency services Birthing friendly

Holy Family Memorial

Acute Care Hospitals · Manitowoc, WI

3/5 CMS rating

OwnershipVoluntary non-profit - Other

CMS Certification Number520107

Location2300 Western AveManitowoc, WI 54221 · Manitowoc County

Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 54220 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$82.92 typical visit price

range $53.90 – $163.24

Typical copayment $20.73 (range $13.47 – $40.81)

Most-billed visit code 99203

Established Patient

$95.41 typical visit price

range $17.40 – $133.76

Typical copayment $23.85 (range $4.35 – $33.44)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Referred Medical Equipment & Supplies CMS DME claims 5

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253

DME-Other DME · category DE017N

6 suppliers17 claims67 services$5.12 avg. paid by Medicare

Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing E0431

DME-Oxygen and Supplies · category DC000N

2 suppliers11 claims11 services$21.20 avg. paid by Medicare

Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate E1390

DME-Oxygen and Supplies · category DC002N

4 suppliers31 claims31 services$115.22 avg. paid by Medicare

Portable oxygen concentrator, rental E1392

DME-Oxygen and Supplies · category DC002N

2 suppliers17 claims17 services$35.84 avg. paid by Medicare

Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service K0553

DME-Other DME · category DE017N

4 suppliers28 claims28 services$194.96 avg. paid by Medicare

Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 11

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. GREGORY SHOICHI ISHIMOTO M.D.

Family Medicine