Cheryl A Kolkovich, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1649 Issued in WI

Practice address

840 W Racine St
Jefferson, WI 53549-1053

Phone

(920) 674-6000

Fax

(920) 674-3034

NPI assigned

Jul 5, 2005

Sex

Female

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 1

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: No

Green means eligible to order or refer.

Enrollment records 1

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 and National Provider Directory roles.

• Fort Healthcare Inc

  • Otolaryngology Physician
  • Fort Atkinson, WI
  • NPI 1417993361
  Medicare reassignment
• Fort Healthcare, Inc.

  • General Acute Care Hospital
  • Fort Atkinson, WI
  • NPI 1811916281
  NPD
• Dean Health Systems, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Portage, WI
  • NPI 1427085679
  NPD (past)

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

{
    "created_epoch": "1120521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669593600000",
    "number": "1326045485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 249",
            "city": "FORT ATKINSON",
            "state": "WI",
            "postal_code": "535380249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 W RACINE ST",
            "city": "JEFFERSON",
            "state": "WI",
            "postal_code": "535491053",
            "telephone_number": "920-674-6000",
            "fax_number": "920-674-3034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLKOVICH",
        "first_name": "CHERYL",
        "middle_name": "A",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-05",
        "last_updated": "2022-11-28",
        "certification_date": "2022-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "1649",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41978500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Kiersten, LPC-IT, LMFT-IT
• Tammy J. King, LCSW
• Allison Marie Klimesh, MD
• Kassie Kluge
• Jessica Marie Knurek, LCSW
• Hildegard Kopp
• Alicia Kraucunas
• Abigail Jane Krueger, MS, CCC-SLP
• Cory R Krueger, MS, LPC-IT, SAC-IT
• Kari Lynn Kuffer, MS

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.