Raena Sue Deperry, AUD

Primary specialty

AudiologistTaxonomy code 231H00000X

License

515-156 Issued in WI

Practice address

401 Stageline Rd
Ste. 6
Hudson, WI 54016-7897

Phone

(715) 531-6710

Fax

(715) 531-6711

NPI assigned

Sep 28, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI, MN2 enrollments

Enrollment records 2

Specialty

Qualified Audiologist

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jka5 Hudson IncGroup PAC ID 1850661075, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Jka5 Hudson Inc

  • Audiologist
  • Hudson, WI
  • NPI 1417484239
  Medicare reassignment Care Compare group
• Park Nicollet Clinic

  • Family Medicine Physician
  • St Louis Park, MN
  • NPI 1780621904
  Medicare reassignment NPD
• Park Nicollet Clinic

  • Family Medicine Physician
  • St Louis Park, MN
  • NPI 1063897593
  NPD
• Hudson Hearing & Speech Clinic Inc

  • Audiologist
  • Hudson, WI
  • NPI 1710984562
  NPD (past)
• Audigycare, LLC

  • Audiologist-Hearing Aid Fitter
  • Vancouver, WA
  • NPI 1720364920
  NPD (past)
• Northland Hearing Centers, Inc.

  • Hearing and Speech Clinic/Center
  • Sparta, IL
  • NPI 1184677791
  NPD (past)

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1197417600000",
    "number": "1114018447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1119 STATE ST APT 164",
            "city": "RIVER FALLS",
            "state": "WI",
            "postal_code": "540223403",
            "telephone_number": "715-426-0223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 STAGELINE RD",
            "address_2": "STE. 6",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "540167897",
            "telephone_number": "715-531-6710",
            "fax_number": "715-531-6711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEPERRY",
        "first_name": "RAENA",
        "middle_name": "SUE",
        "name_prefix": "Dr.",
        "credential": "AUD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-28",
        "last_updated": "2007-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "FM",
            "license": "8072",
            "primary": false
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "WI",
            "license": "515-156",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MHCP",
            "identifier": "849410000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Benjamin Jeffrey Danovsky, DPT
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• Rebekah Dean
• Melissa Mae Deeg, D.D.S.
• Kelly L Delahunty, MD
• David Deuth, DO
• Chelsea Eileen Deutsch, LCSW
• Timothy Dale Devries, CRNA
• Magdala Diersen
• Marie Dimenna

• Audiologist in Hudson, WI
• Providers in Hudson, WI by specialty
• Audiologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.