NPIMap

Individual provider Active NPI

Kristin M Lavenhagen, PA-C

  • Physician Assistant
  • Oak Creek, WI
National Provider Identifier
1154635860
Registry record updated Sep 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2636-23 Issued in WI
Practice address
331 E Puetz Rd
Lakeshore Medical Clinic
Oak Creek, WI 53154-3253
Phone
(414) 570-3590
NPI assigned
Aug 5, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2012

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 2636-23 WI Primary

Addresses

Primary practice location

331 E Puetz Rd
Lakeshore Medical Clinic
Oak Creek, WI 53154-3253

Mailing address

100 15TH Avenue
Lakeshore Medical Clinic
South Milwaukee, WI 53172-1160
Phone (414) 768-5430

Other identifiers 1

IdentifierTypeStateIssuer
2636-23OtherWIWISCONSIN LICENSE

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
I20101012001269 WI Practitioner - Physician Assistant 8123210838 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Oak Medical SCGroup PAC ID 0042595175, 118 clinicians
Maple Medical SCGroup PAC ID 9032471248, 25 clinicians

Practice addresses (Care Compare)

110 Belmont Rd
Madison, WI 53714-3129
Phone (608) 249-7391

13755 W Fieldpoint Dr
New Berlin, WI 53151-3979
Phone (262) 796-3660

19525 W N Ave
Brookfield, WI 53045-4107
Phone (262) 785-1114

2195 N Summit Village Way
Oconomowoc, WI 53066-8675
Phone (262) 567-4662

645 N Church St
Elkhorn, WI 53121-2204
Phone (262) 723-4963

700 Clark St
Lodi, WI 53555-1010
Phone (608) 592-3241

7500 W Dean Rd
Milwaukee, WI 53223-2638
Phone (414) 371-7300

9301 N 76TH St
Milwaukee, WI 53223-1074
Phone (414) 355-9300

N20W22961 Watertown Rd
Waukesha, WI 53186-1306
Phone (262) 875-5070

W173N10915 Bernies Way
Germantown, WI 53022-4043
Phone (262) 509-3300

Hospital & facility affiliations

  • Holy Family Memorial Hospital, Manitowoc, WI, CCN 520107
  • Aspirus Wausau Hospital Hospital, Wausau, WI, CCN 520030

National Provider Directory

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

Organizations & group practices 2

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 11

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": "1280966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348790400000",
    "number": "1154635860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 15TH AVENUE",
            "address_2": "LAKESHORE MEDICAL CLINIC",
            "city": "SOUTH MILWAUKEE",
            "state": "WI",
            "postal_code": "531721160",
            "telephone_number": "414-768-5430",
            "fax_number": "414-762-4225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "331 E PUETZ RD",
            "address_2": "LAKESHORE MEDICAL CLINIC",
            "city": "OAK CREEK",
            "state": "WI",
            "postal_code": "531543253",
            "telephone_number": "414-570-3590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAVENHAGEN",
        "first_name": "KRISTIN",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-05",
        "last_updated": "2012-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "2636-23",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WISCONSIN LICENSE",
            "identifier": "2636-23",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oak Creek, WI

Sources for this page

Verify at the official NPI Registry.