Matthew Anthony Hettenbach, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

10089 Issued in WI

Practice address

1244 Wisconsin Ave
Racine, WI 53403-1987

Phone

(262) 687-2956

NPI assigned

May 29, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Ascension Medical Group-Southeast Wisconsin IncGroup PAC ID 8628980943, 551 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ascension All Saints Hospital Hospital, Racine, WI, CCN 520096

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Ascension Medical Group-Southeast Wisconsin Inc

  • Internal Medicine Physician
  • Glendale, WI
  • NPI 1609881077
  Medicare reassignment Care Compare group NPD
• Ascension All Saints Hospital, Inc

  • Rehabilitation Hospital Unit
  • Racine, WI
  • NPI 1417966540
  NPD (past)

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

• Ascension All Saints Hospital, Inc

  • General Acute Care Hospital
  • Racine, WI
  • NPI 1639123284
  Care Compare affiliation

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

{
    "created_epoch": "1590710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590710400000",
    "number": "1003430729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2019 SAINT CLAIR ST",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534024763",
            "telephone_number": "262-995-4662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1244 WISCONSIN AVE",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534031987",
            "telephone_number": "262-687-2956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HETTENBACH",
        "first_name": "MATTHEW",
        "middle_name": "ANTHONY",
        "credential": "PMHNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-05-29",
        "last_updated": "2020-05-29",
        "certification_date": "2020-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WI",
            "license": "10089",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy Rebecca Herron, RN
• Herslof'S, Inc
• Herslof'S, Inc
• Leslie M Hertz, MD
• Terry Donald Hess
• Mariah Hewitt, PSYD
• William John Hexom, PHARM.D.
• Lester Leslie Higgenbottom, LCSW, LPC, CADCIII
• Christine Higginbotham
• Tanya Higgins, CRNA

• Psychiatric/Mental Health Nurse Practitioner in Racine, WI
• Providers in Racine, WI by specialty
• Psychiatric/Mental Health Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.