NPIMap

Individual provider Active NPI

Nathaniel Joseph Retrum, PA-C

  • Medical Physician Assistant
  • Antigo, WI
National Provider Identifier
1336548627
Registry record updated Aug 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
3377-23 Issued in WI
Practice address
110 E 5TH Ave
Antigo, WI 54409-2710
Phone
(715) 623-2351
NPI assigned
Aug 22, 2014
Last updated
Aug 22, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 3377-23 WI Primary

Addresses

Primary practice location

110 E 5TH Ave
Antigo, WI 54409-2710

Mailing address

110 East Fifth Avenue
Antigo, WI 54409

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
I20141210001918 WI Practitioner - Physician Assistant 9537481130 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Langlade Hospital - Hotel Dieu of St Joseph of Antigo WisconsinGroup PAC ID 1557271202, shared by 7 NPIs, 86 clinicians

Practice addresses (Care Compare)

110 E 5TH Ave
Antigo, WI 54409-2710
Phone (715) 623-2351

112 E 5TH Ave
Antigo, WI 54409-2710
Phone (715) 623-2331

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.2 of 100Reported as group
Quality
84.08
Promoting interoperability
100
Improvement activities
40
Cost
64.31

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3377-23WIMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Aspirus Medical Group, Inc. CurrentSince Sep 15, 2014 Accepting new patients
Langlade Hospital - Hotel Dieu of St Joseph of Antigo Wisconsin CurrentSince Jan 17, 2026 Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

110 E 5th Ave
Antigo, WI 54409
Phone (715) 623-2351

604 S Webb St
Wittenberg, WI 54499
Phone (715) 253-2037

Interoperability endpoints

  • Direct secure messaging: nretrum103555@direct.aspirus.org

Organizations & group practices 4

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.

Hospital & facility affiliations 29

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1408665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1408665600000",
    "number": "1336548627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 EAST FIFTH AVENUE",
            "city": "ANTIGO",
            "state": "WI",
            "postal_code": "54409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 E 5TH AVE",
            "city": "ANTIGO",
            "state": "WI",
            "postal_code": "544092710",
            "telephone_number": "715-623-2351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RETRUM",
        "first_name": "NATHANIEL",
        "middle_name": "JOSEPH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-08-22",
        "last_updated": "2014-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WI",
            "license": "3377-23",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Antigo, WI

Sources for this page

Verify at the official NPI Registry.