Individual provider Active NPI

Kelli Louise Sasada, M.D.

  • Gynecology Physician
  • Pleasant Prairie, WI
National Provider Identifier
1265698690
Registry record updated Aug 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecology PhysicianTaxonomy code 207VG0400X
License
57485 Issued in WI
Practice address
9555 76TH St
Suite 4105
Pleasant Prairie, WI 53158-1984
Phone
(262) 577-8080
Fax
(262) 577-8081
NPI assigned
Aug 5, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecology Physician 207VG0400X MD60215747 WA
Gynecology Physician 207VG0400X 57485 WI Primary

Addresses

Primary practice location

9555 76TH St
Suite 4105
Pleasant Prairie, WI 53158-1984

Mailing address

9555 76TH St
Suite 4105
Pleasant Prairie, WI 53158-1984
Phone (262) 577-8080

Other identifiers 2

IdentifierTypeStateIssuer
0281999OtherWADEPT OF LABOR & INDUSTRIES
1265698690MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121114000198 WI Practitioner - Obstetrics/Gynecology 9032389804 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Froedtert South IncGroup PAC ID 9537071196, 158 clinicians

Practice addresses (Care Compare)

9555 76TH St
Pleasant Prairie, WI 53158-1984
Phone (262) 577-8300

Hospital & facility affiliations

  • Froedtert South Inc. Hospital, Kenosha, WI, CCN 520021

Merit-based Incentive Payment System (MIPS)

Final score
83.15 of 100Reported as group
Quality
69.39
Promoting interoperability
100
Improvement activities
40
Cost
74.44

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of the uterus1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD60215747WAMDGynecology Physician
57485WIMDGynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Froedtert South, Inc. CurrentSince Oct 1, 2012 Accepting new patients
Kenosha Pathology Consultants Past Accepting new patients
Froedtert South, Inc. Past Accepting new patients

Locations

6308 8th Ave
Kenosha, WI 53143
Phone (262) 653-5300

9555 76th St
Pleasant Prairie, WI 53158
Phone (262) 577-8000

9555 76th St
Ste 4105
Pleasant Prairie, WI 53158
Phone (262) 577-8080

Interoperability endpoints

  • Direct secure messaging: kcheregi339879@direct.froedtert.com

Organizations & group practices 3

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 1

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": "1217894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1344556800000",
    "number": "1265698690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9555 76TH ST",
            "address_2": "SUITE 4105",
            "city": "PLEASANT PRAIRIE",
            "state": "WI",
            "postal_code": "531581984",
            "telephone_number": "262-577-8080",
            "fax_number": "262-577-8081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9555 76TH ST",
            "address_2": "SUITE 4105",
            "city": "PLEASANT PRAIRIE",
            "state": "WI",
            "postal_code": "531581984",
            "telephone_number": "262-577-8080",
            "fax_number": "262-577-8081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SASADA",
        "first_name": "KELLI",
        "middle_name": "LOUISE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-05",
        "last_updated": "2012-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "WA",
            "license": "MD60215747",
            "primary": false
        },
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "WI",
            "license": "57485",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF LABOR & INDUSTRIES",
            "identifier": "0281999",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1265698690",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pleasant Prairie, WI

Sources for this page

Verify at the official NPI Registry.