Glenn J Kruser, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

183-023 Issued in WI

Practice address

10 N Water St
Evansville, WI 53536-1152

Phone

(608) 882-5170

Fax

(608) 882-6532

NPI assigned

May 10, 2006

Last updated

Apr 30, 2014By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• St. Marys Dean Ventures Inc.

  • Clinic/Center
  • Baraboo, WI
  • NPI 1811944093
  NPD
• Dean Health Systems, Inc,

  dba Dean Clinic-Beaver Dam Family & Sports Orthopedic Center

  • Durable Medical Equipment & Medical Supplies
  • Beaver Dam, WI
  • NPI 1336425016
  NPD (past)

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

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398816000000",
    "number": "1174573497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 N WATER ST",
            "city": "EVANSVILLE",
            "state": "WI",
            "postal_code": "535361152",
            "telephone_number": "608-882-5170",
            "fax_number": "680-882-6532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 N WATER ST",
            "city": "EVANSVILLE",
            "state": "WI",
            "postal_code": "535361152",
            "telephone_number": "608-882-5170",
            "fax_number": "608-882-6532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRUSER",
        "first_name": "GLENN",
        "middle_name": "J",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-10",
        "last_updated": "2014-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "183-023",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42909900",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIANS PLUS",
            "identifier": "1026026",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEAN HEALTH INSURANCE",
            "identifier": "2981",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeremy S Kim, DO
• Kindling Wellness LLC
• Renee Corinne Kinney, LPN
• Kim Ellen Kline, PTA
• Kiara Krohn
• Katie Ann Kulis, COTA
• Brianne Lochrie, NP
• Lindsey Andrea Lopp, PT, DPT
• Karmen Lee Maag
• Ronald B. Mabie, R.PH

• Physician Assistant in Evansville, WI
• Providers in Evansville, WI by specialty
• Physician Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.