NPIMap

Individual provider Active NPI

Katherine D. Ketterhagen, PA-C

  • Physician Assistant
  • Janesville, WI
National Provider Identifier
1356414668
Registry record updated Nov 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1757-23 Issued in WI
Practice address
3200 E Racine St
Janesville, WI 53546-2343
Phone
(608) 371-8000
Fax
(608) 371-8008
NPI assigned
Nov 16, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2020

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 1757-23 WI Primary

Addresses

Primary practice location

3200 E Racine St
Janesville, WI 53546-2343

Mailing address

1446 N Randall Ave
Janesville, WI 53545-1122
Phone (608) 758-7215

Other identifiers 2

IdentifierTypeStateIssuer
41992300MedicaidWI
61167OtherWIDEAN HEALTH SYSTEMS, INC

Other names 1

  • Katherine D Danna Former name

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address kketterhagen259740@direct-ehr-ssmhc.com Direct
FHIR URL https://fhir.ssmhc.com/fhir/api.FHIR/DSTU2/ Other

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
I20041022001046 WI Practitioner - Physician Assistant 8628039658 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Edgerton Hospital and Health Services, IncGroup PAC ID 7719874502, 40 clinicians
Stoughton Hospital AssociationGroup PAC ID 7012825706, 66 clinicians
Swea Fort SCGroup PAC ID 0345774972, 51 clinicians

Practice addresses (Care Compare)

4 Burdick St
Edgerton, WI 53534-1729
Phone (608) 884-3441

5614 US Hwy 51
McFarland, WI 53558-8708
Phone (608) 838-8242

611 Sherman Ave E
Fort Atkinson, WI 53538-1960
Phone (920) 568-5475

900 Ridge St
Stoughton, WI 53589-1864
Phone (608) 873-6611

Hospital & facility affiliations

  • Fort Memorial Hospital Hospital, Fort Atkinson, WI, CCN 520071
  • Stoughton Hospital Hospital, Stoughton, WI, CCN 521343

Merit-based Incentive Payment System (MIPS)

Final score
85.73 of 100Reported as group
Quality
87.42
Promoting interoperability
100
Improvement activities
40
Cost
65.02

Merit-based Incentive Payment System (MIPS)

Final score
69.34 of 100Reported as group
Quality
87.81
Promoting interoperability
100
Improvement activities
40
Cost
10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Edgerton Hospital and Health Services, Inc CurrentSince Mar 11, 2024 Accepting new patients
Stoughton Hospital Association CurrentSince Apr 8, 2013 Accepting new patients
Stoughton Hospital Association CurrentSince Apr 8, 2013 Accepting new patients
Edgerton Hospital and Health Services Inc. CurrentSince Mar 11, 2024 Accepting new patients
Stoughton Hospital Association Past Accepting new patients
Emergency Medicine Physicians of Kankakee County, LLC Past Accepting new patients
Edgerton Hospital and Health Services Past Accepting new patients

Locations

110 Limestone Pass
Ste 103
Cottage Grove, WI 53527

11101 N Sherman Rd
Edgerton, WI 53534
Phone (608) 884-1695

5614 US Highway 51
McFarland, WI 53558
Phone (608) 838-8242

831 Arthur Dr
Milton, WI 53563
Phone (608) 868-3526

990 Janesville St
Ste L
Oregon, WI 53575

900 Ridge St
Stoughton, WI 53589
Phone (608) 231-3410

Interoperability endpoints

  • Direct secure messaging: kketterhagen259740@direct-ehr-ssmhc.com
  • Direct secure messaging: kketterhagen2573@direct.mhsjvl.org

Organizations & group practices 9

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 5

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": "1163635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604361600000",
    "number": "1356414668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1446 N RANDALL AVE",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535451122",
            "telephone_number": "608-758-7215",
            "fax_number": "608-758-3216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 E RACINE ST",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535462343",
            "telephone_number": "608-371-8000",
            "fax_number": "608-371-8008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETTERHAGEN",
        "first_name": "KATHERINE",
        "middle_name": "D.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-16",
        "last_updated": "2020-11-03",
        "certification_date": "2020-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "1757-23",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41992300",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEAN HEALTH SYSTEMS, INC",
            "identifier": "61167",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kketterhagen259740@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "kketterhagen259740@direct-ehr-ssmhc.com",
            "address_1": "1223 E Main St",
            "city": "Perry",
            "state": "MO",
            "country_code": "US",
            "postal_code": "634621410",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api.FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "1223 E Main St",
            "city": "Perry",
            "state": "MO",
            "country_code": "US",
            "postal_code": "634621410",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KATHERINE",
            "last_name": "DANNA",
            "middle_name": "D",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Janesville, WI

Sources for this page

Verify at the official NPI Registry.