Susan H Kreckman, MD
Individual provider Active NPI Family Medicine Physician · Portage, WI
NPI 1376527002 · NPPES record last updated Oct 14, 2011
Key facts
- NPI
- 1376527002
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 39356 (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
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 7
Owned or controlled facilities with NPI records 11
Medicare Care Compare profile
- 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 Inc
Practice addresses (Care Compare)
2817 New Pinery Rd
Portage, WI 53901-9240
Phone (608) 742-4131
Hospital & facility affiliations
- Aspirus at Home
- Aveanna Home Health
- SSM Health at Home Home Health-Wisconsin
- Agrace Hospicecare
- Aspirus Divine Savior Hospital
- University of Wi Hospitals & Clinics Authority
- SSM Health St Clare Hospital - Baraboo
Merit-based Incentive Payment System (MIPS)
- Final score
- 91.7 of 100
- Quality
- 91.14
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 77.5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
All facility ownership & control disclosures 10
| Facility | Type | Role | Since |
|---|---|---|---|
| Aspirus Divine Savior Hospital |
Hospital | Corporate Director | Jan 31, 2020 |
| Aspirus Wisconsin Rapids Hospital |
Hospital | Corporate Director | Sep 30, 2023 |
| Aspirus Stevens Point Hospital & Clinics, Inc. |
Hospital | Corporate Director | Sep 30, 2023 |
| Aspirus Wisconsin Rapids Clinic - Peach Street |
Rural health clinic | Corporate Director | Sep 30, 2023 |
| Aspirus Wisconsin Rapids Clinic - Dewey Street |
Rural health clinic | Corporate Director | Sep 30, 2023 |
| Aspirus Nekoosa Clinic |
Rural health clinic | Corporate Director | Sep 30, 2023 |
| Aspirus Oxford Clinic |
Rural health clinic | Corporate Director | Jan 31, 2020 |
| Aspirus Portage Clinic |
Rural health clinic | Corporate Director | Jan 31, 2020 |
| Aspirus Adams Clinic |
Rural health clinic | Corporate Director | Sep 30, 2023 |
| Aspirus Clinic - Marshfield |
Rural health clinic | Corporate Director | Sep 30, 2023 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040608001258 | WI | Practitioner - Family Practice | 3678467701 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 39356 | WI | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Divine Savior Healthcare, Inc. | Family Medicine | Current |
Accepting new patients |
| Divine Savior Healthcare, Inc. | Current |
Accepting new patients |
Locations
29980 Network Pl
Chicago, IL 60673
2817 New Pinery Rd
Portage, WI 53901
Phone (608) 745-4598
Interoperability endpoints
- skreckman159962@direct.aspirus.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 39356 | WI | Yes |
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
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 32379600 | Medicaid | WI |
Other providers in Portage, WI
- Jamie John Kling
- Susan A Knower
- Emily Kraemer
- Ogoma Mekam Obi Krause
- Sarah J Kravick
- Jennifer J Krey
- Gerald L Krumpos
- Joseph Michael Labella
- Mark T Labor
- Kendra Lynn Lacrosse
All providers in Portage, WI · Family Medicine Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 14, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.