Clayton W Keene, FNP
Individual provider Active NPI Nurse Practitioner · Oconto, WI
NPI 1134595051 · NPPES record last updated Aug 28, 2024
Key facts
- NPI
- 1134595051
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 6529-33 (WI)
- Practice address
- 530 Smith Ave
Oconto, WI 54153-1010 - Phone
- (920) 834-7600
- NPI assigned
- Aug 14, 2015
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Aurora Medical Group, Inc.
Practice addresses (Care Compare)
530 Smith Ave
Oconto, WI 54153-1010
Phone (920) 834-7600
Hospital & facility affiliations
- Aurora Medical Center Bay Area
- Aurora Baycare Medical Ctr
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151001002581 | WI | Practitioner - Nurse Practitioner | 7416265962 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6529-33 | WI | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aurora Medical Group, Inc. | Current |
Accepting new patients | |
| Aurora Medical Group, Inc. | Current | Accepting new patients | |
| Aurora Medical Group, Inc. | Current |
Accepting new patients |
Locations
835 S Van Buren St
Green Bay, WI 54301
Phone (888) 901-7246
3301 W Forest Home Ave
Milwaukee, WI 53215
Phone (414) 389-2233
1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056
530 Smith Ave
Oconto, WI 54153
Phone (920) 834-7600
855 S Main St
Ste 1
Oconto Falls, WI 54154
Phone (920) 846-8187
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 6529-33 | WI | Yes |
Addresses
Primary practice location
530 Smith Ave
Oconto, WI 54153-1010
Mailing address
PO Box 735044
Chicago, IL 60673-5044
Phone (800) 326-2250
Other practice location 1
14353 State Highway 32 64
Mountain, WI 54149-9656
Phone (715) 276-1600
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568552958 | Other | WI | CLINIC NPI |
| 100047664 | Medicaid | WI | |
| 1851477913 | Other | WI | ST. CLARE NPI |
Other providers in Oconto, WI
- Todd Robert Holman
- John S Honish
- Nathan W Jackson
- Briana Jones
- Matthew James Karban
- Jaclyn Ann Keller
- Jessica Kerwin
- Thomas J. Knutson
- Jonathan Koby
- Susan M Koeune
All providers in Oconto, WI · Nurse Practitioner in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 28, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.