Individual provider Active NPI

Suzette Linda Katchko, APNP

  • Nurse Practitioner
  • Crandon, WI
National Provider Identifier
1073773677
Registry record updated Oct 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
3553 Issued in WI
Practice address
3144 Vanzile Rd
Crandon, WI 54520-8149
Phone
(715) 478-5180
NPI assigned
Jun 17, 2008
Last updated
Oct 3, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 3553 WI Primary

Addresses

Primary practice location

3144 Vanzile Rd
Crandon, WI 54520-8149

Mailing address

3144 Vanzile Rd
Crandon, WI 54520-8149
Phone (715) 478-5180

Other names 1

  • Miss Suzette Linda Raisbeck Former name

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20090121000668 WI Practitioner - Nurse Practitioner 4880758721 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sokaogon Chippewa CommunityGroup PAC ID 1759370869, 13 clinicians

Practice addresses (Care Compare)

3144 Vanzile Rd
Crandon, WI 54520-8149
Phone (715) 478-5180

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3553WIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Sokaogon Chippewa Community CurrentSince Oct 1, 2021 Accepting new patients
Aspirus Rhinelander & Tomahawk Hospitals & Clinics, Inc. CurrentSince Oct 27, 2008 Accepting new patients
Aspirus Rhinelander & Tomahawk Hospitals & Clinics, Inc. CurrentSince Oct 27, 2008 Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

3144 Vanzile Rd
Crandon, WI 54520
Phone (715) 478-5180

400 W Glen St
Crandon, WI 54520
Phone (715) 478-3318

2251 N Shore Dr
Rhinelander, WI 54501
Phone (715) 361-2300

2251 N Shore Dr
Ste 100
Rhinelander, WI 54501
Phone (715) 361-2074

2251 N Shore Dr
Ste 200
Rhinelander, WI 54501
Phone (715) 361-4634

401 W Mohawk Dr
Ste 100
Tomahawk, WI 54487
Phone (715) 453-7700

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.73753
  • Direct secure messaging: suzette.katchko@schc.directbygreenway.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1213660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664755200000",
    "number": "1073773677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3144 VANZILE RD",
            "city": "CRANDON",
            "state": "WI",
            "postal_code": "545208149",
            "telephone_number": "715-478-5180",
            "fax_number": "715-478-5904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3144 VANZILE RD",
            "city": "CRANDON",
            "state": "WI",
            "postal_code": "545208149",
            "telephone_number": "715-478-5180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KATCHKO",
        "first_name": "SUZETTE",
        "middle_name": "LINDA",
        "name_prefix": "Mrs.",
        "credential": "APNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-17",
        "last_updated": "2022-10-03",
        "certification_date": "2022-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "3553",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUZETTE",
            "last_name": "RAISBECK",
            "middle_name": "LINDA",
            "prefix": "MISS",
            "credential": "APNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Crandon, WI

Sources for this page

Verify at the official NPI Registry.