NPIMap

Individual provider Active NPI

Ajhani Kesavan, MD

  • Family Medicine Physician
  • Sheboygan, WI
National Provider Identifier
1043837271
Registry record updated Jan 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
82441-20 Issued in WI
Practice address
1411 N Taylor Dr
Sheboygan, WI 53081-3043
Phone
(920) 496-4700
Fax
(603) 228-7307
NPI assigned
Jul 4, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X RT-3658 NH
Family Medicine Physician 207Q00000X 82441-20 WI Primary

Addresses

Primary practice location

1411 N Taylor Dr
Sheboygan, WI 53081-3043

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
100252791MedicaidWI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address akesavan395131@ewd.direct.hshs.org Direct

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
I20231114002156 WI Practitioner - Family Practice 1759708043 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1411 N Taylor Dr
Sheboygan, WI 53081-3043
Phone (920) 457-4858

835 S Van Buren St
Green Bay, WI 54301-3526
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
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Prevea Clinic, Inc. Family Medicine CurrentSince Sep 4, 2023 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis Family Medicine CurrentSince Sep 4, 2023 Accepting new patients
St Nicholas Hospital-Sisters of the Third Order of St Francis CurrentSince Sep 4, 2023 Accepting new patients
Prevea Clinic, Inc. Family Medicine Current Accepting new patients
St Nicholas Hospital-Sisters of the Third Order of St Francis CurrentSince Sep 4, 2023 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis CurrentSince Sep 4, 2023 Accepting new patients
St. Nicholas Hospital-Sisters of the Third Order of St Francis Family Medicine Current 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

3100 Superior Ave
Sheboygan, WI 53081
Phone (800) 472-6710

1411 N Taylor Dr
Sheboygan, WI 53081
Phone (920) 457-1600

Interoperability endpoints

  • Direct secure messaging: akesavan395131@ewd.direct.hshs.org

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 8

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

NPI Registry JSON

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

{
    "created_epoch": "1593820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705536000000",
    "number": "1043837271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19070",
            "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": "1411 N TAYLOR DR",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "530813043",
            "telephone_number": "920-496-4700",
            "fax_number": "603-228-7307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KESAVAN",
        "first_name": "AJHANI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-04",
        "last_updated": "2024-01-18",
        "certification_date": "2024-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NH",
            "license": "RT-3658",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "82441-20",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100252791",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "akesavan395131@ewd.direct.hshs.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "1411 N Taylor Dr",
            "city": "Sheboygan",
            "state": "WI",
            "country_code": "US",
            "postal_code": "530813043",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Sheboygan, WI

Sources for this page

Verify at the official NPI Registry.