NPIMap

Individual provider Active NPI

Susan H Kreckman, MD

  • Family Medicine Physician
  • Portage, WI
National Provider Identifier
1376527002
Registry record updated Oct 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
39356 Issued in WI
Practice address
2817 New Pinery Rd.
Divine Savior Healthcare, Inc.
Portage, WI 53901-0387
Phone
(608) 745-4598
Fax
(608) 745-6242
NPI assigned
Dec 6, 2005
Last updated
Oct 14, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 39356 WI Primary

Addresses

Primary practice location

2817 New Pinery Rd.
Divine Savior Healthcare, Inc.
Portage, WI 53901-0387

Mailing address

2817 New Pinery Rd.
Divine Savior Healthcare, Inc.
Portage, WI 53901-0387
Phone (608) 745-4598

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
I20040608001258 WI Practitioner - Family Practice 3678467701 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Wayne State University School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Divine Savior Healthcare IncGroup PAC ID 5799684007, 135 clinicians

Practice addresses (Care Compare)

2817 New Pinery Rd
Portage, WI 53901-9240
Phone (608) 742-4131

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.7 of 100Reported as group
Quality
91.14
Promoting interoperability
100
Improvement activities
40
Cost
77.5

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Divine Savior Healthcare, Inc. Family Medicine CurrentSince Nov 3, 1997 Accepting new patients
Divine Savior Healthcare, Inc. CurrentSince Nov 3, 1997 Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

2817 New Pinery Rd
Portage, WI 53901
Phone (608) 745-4598

Interoperability endpoints

  • Direct secure messaging: skreckman159962@direct.aspirus.org

Ownership & related parties

All facility ownership & control disclosures 10

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Aspirus Divine Savior HospitalPortage, WI, CCN 520041 Hospital Corporate Director Jan 31, 2020
Aspirus Wisconsin Rapids HospitalWisconsin Rapids, WI, CCN 520033 Hospital Corporate Director Sep 30, 2023
Aspirus Stevens Point Hospital & Clinics, Inc.Stevens Point, WI, CCN 520002 Hospital Corporate Director Sep 30, 2023
Aspirus Wisconsin Rapids Clinic - Peach StreetWisconsin Rapids, WI, CCN 528576 Rural health clinic Corporate Director Sep 30, 2023
Aspirus Wisconsin Rapids Clinic - Dewey StreetWisconsin Rapids, WI, CCN 528575 Rural health clinic Corporate Director Sep 30, 2023
Aspirus Nekoosa ClinicNekoosa, WI, CCN 528581 Rural health clinic Corporate Director Sep 30, 2023
Aspirus Oxford ClinicOxford, WI, CCN 528594 Rural health clinic Corporate Director Jan 31, 2020
Aspirus Portage ClinicPortage, WI, CCN 528593 Rural health clinic Corporate Director Jan 31, 2020
Aspirus Adams ClinicAdams, WI, CCN 528616 Rural health clinic Corporate Director Sep 30, 2023
Aspirus Clinic - MarshfieldMarshfield, WI, CCN 528661 Rural health clinic Corporate Director Sep 30, 2023

Owned or controlled facilities with NPI records 11

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 2

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 7

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": "1133827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318550400000",
    "number": "1376527002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2817 NEW PINERY RD.",
            "address_2": "DIVINE SAVIOR HEALTHCARE, INC.",
            "city": "PORTAGE",
            "state": "WI",
            "postal_code": "539010387",
            "telephone_number": "608-745-4598",
            "fax_number": "608-745-6242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2817 NEW PINERY RD.",
            "address_2": "DIVINE SAVIOR HEALTHCARE, INC.",
            "city": "PORTAGE",
            "state": "WI",
            "postal_code": "539010387",
            "telephone_number": "608-745-4598",
            "fax_number": "608-745-6242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRECKMAN",
        "first_name": "SUSAN",
        "middle_name": "H",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-06",
        "last_updated": "2011-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "39356",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portage, WI

Sources for this page

Verify at the official NPI Registry.