NPIMap

Individual provider Active NPI

Katie Lyn Beahm, PA-C

  • Physician Assistant
  • Onalaska, WI
National Provider Identifier
1083049985
Registry record updated Apr 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
3194 - 23 Issued in WI
Practice address
191 Theater Rd
Onalaska, WI 54650-8679
Phone
(608) 785-0940
NPI assigned
Sep 10, 2013
Last updated
Apr 23, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 3194 - 23 WI Primary

Addresses

Primary practice location

191 Theater Rd
Onalaska, WI 54650-8679

Mailing address

200 1St St SW
Rochester, MN 55905-0002
Phone (608) 785-0940

Other practice location 1

18061 Lincoln St
Whitehall, WI 54773
Phone (715) 538-4361

Other names 1

  • Katie Lyn Tacke Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ketten25936@ehrdirect.mayoclinicmsg.org

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
I20131126000293 WI Practitioner - Physician Assistant 7719113638 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Des Moines University of Osteopathic Medicine and Health Sciences, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

191 Theater Rd
Onalaska, WI 54650-8679
Phone (608) 392-5000

800 E Blackhawk Ave
Prairie Du Chien, WI 53821-1698
Phone (608) 326-0808

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
3194 - 23WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Tri-County Memorial Hospital Inc CurrentSince Oct 1, 2013 Accepting new patients
Gundersen Lutheran Express Care, Inc CurrentSince Dec 22, 2014 Accepting new patients
Tri-County Memorial Hospital, Inc. CurrentSince Oct 1, 2013 Accepting new patients
Gundersen Clinic LTD CurrentSince Dec 22, 2014 Accepting new patients
Mayo Clinic Health System-Southwest Wisconsin Region, Inc. CurrentSince Jan 20, 2017 Accepting new patients
Gundersen Clinic LTD Past Accepting new patients

Locations

200 1st St SW
Rochester, MN 55905
Phone (507) 266-4850

1600 Main St
Onalaska, WI 54650
Phone (608) 783-4681

191 Theater Rd
Onalaska, WI 54650
Phone (608) 392-5000

705 E Taylor St
Prairie du Chien, WI 53821
Phone (608) 357-2000

800 E Blackhawk Ave
Prairie du Chien, WI 53821
Phone (608) 326-0808

310 W Main St
Sparta, WI 54656
Phone (608) 269-1700

18601 Lincoln St
Whitehall, WI 54773
Phone (715) 538-1712

Interoperability endpoints

  • Direct secure messaging: ketten25936@ehrdirect.mayoclinicmsg.org

Organizations & group practices 8

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.

Hospital & facility affiliations 3

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": "1378771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619136000000",
    "number": "1083049985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 1ST ST SW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559050002",
            "telephone_number": "608-785-0940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "191 THEATER RD",
            "city": "ONALASKA",
            "state": "WI",
            "postal_code": "546508679",
            "telephone_number": "608-785-0940"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "18061 Lincoln St",
            "address_purpose": "LOCATION",
            "city": "Whitehall",
            "state": "WI",
            "postal_code": "54773",
            "country_code": "US",
            "telephone_number": "715-538-4361",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BEAHM",
        "first_name": "KATIE",
        "middle_name": "LYN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-10",
        "last_updated": "2021-04-23",
        "certification_date": "2021-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "3194 - 23",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ketten25936@ehrdirect.mayoclinicmsg.org",
            "affiliation": "N",
            "address_1": "191 Theater Rd",
            "city": "Onalaska",
            "state": "WI",
            "country_code": "US",
            "postal_code": "546508679",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KATIE",
            "last_name": "TACKE",
            "middle_name": "LYN",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Onalaska, WI

Sources for this page

Verify at the official NPI Registry.