Katherine E. Gunderson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

3892-23 Issued in WI

Practice address

3400 Deerfield Dr
Janesville, WI 53546-3557

Phone

(608) 314-3600

Fax

(608) 314-3601

NPI assigned

Sep 14, 2016

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

Other names 1

• Katherine E. Mikkelson Other name

Electronic endpoints 2

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

Specialty

Physician Assistant

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Swea Fort SCGroup PAC ID 0345774972, 51 clinicians

Group Health Cooperative of South Central WisconsinGroup PAC ID 3870489586, 233 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Black River Memorial Hospital Hospital, Black River Falls, WI, CCN 521333
• Mile Bluff Medical Center Hospital, Mauston, WI, CCN 520109
• Fort Memorial Hospital Hospital, Fort Atkinson, WI, CCN 520071

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: katherine.gunderson@direct.milebluff.com

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.

• Swea Fort SC

  • Emergency Medicine Physician
  • Fort Atkinson, WI
  • NPI 1295552065
  Medicare reassignment Care Compare group NPD
• Group Health Cooperative of South Central Wisconsin

  • Health Maintenance Organization
  • Madison, WI
  • NPI 1245260165
  Medicare reassignment Care Compare group
• Black River Health Inc

  • Critical Access Hospital
  • Black River Falls, WI
  • NPI 1811940331
  Medicare reassignment NPD
• Mercy Health System Corporation

  dba MHS Physician Services

  • Multi-Specialty Clinic/Center
  • Janesville, WI
  • NPI 1598718603
  Medicare reassignment NPD
• Mile Bluff Medical Center Inc

  dba Mile Bluff ER/UC Providers

  • Emergency Medicine Physician
  • Mauston, WI
  • NPI 1609912005

  Physician Assistant

  Medicare reassignment NPD
• Reedsburg Area Medical Center, Inc.

  • Critical Access Hospital
  • Reedsburg, WI
  • NPI 1891796710
  Medicare reassignment NPD
• Madison Emergency Physicians, SC

  • Emergency Medicine Physician
  • Madison, WI
  • NPI 1588646095
  Medicare reassignment
• Southern Wisconsin Emergency Associates SC

  • Emergency Medicine Physician
  • Beloit, WI
  • NPI 1568538189
  Medicare reassignment
• Thedacare Medical Center - New London, Inc.

  • Critical Access Hospital
  • New London, WI
  • NPI 1538127220
  Medicare reassignment
• Black River Health Inc

  dba Black River Healthcare Clinic

  • Rural Health Clinic/Center
  • Black River Falls, WI
  • NPI 1255183182
  NPD
• Black River Health Inc

  • Oxygen Equipment & Supplies (DME)
  • Black River Falls, WI
  • NPI 1285782250
  NPD
• Mercy Health System Corporation

  dba Mercy Hospital Janesville

  • General Acute Care Hospital
  • Janesville, WI
  • NPI 1093768962
  NPD

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

• Black River Health Inc

  • Critical Access Hospital
  • Black River Falls, WI
  • NPI 1811940331
  Care Compare affiliation
• Fort Healthcare Inc

  • Otolaryngology Physician
  • Fort Atkinson, WI
  • NPI 1417993361

  Hospital

  Care Compare affiliation
• Fort Healthcare, Inc.

  • General Acute Care Hospital
  • Fort Atkinson, WI
  • NPI 1811916281
  Care Compare affiliation
• Mile Bluff Medical Center Inc

  dba Mile Bluff Urgent Care

  • Urgent Care Clinic/Center
  • Mauston, WI
  • NPI 1437958683

  Hospital

  Care Compare affiliation
• Mile Bluff Medical Center Inc

  dba Mile Bluff Hospital

  • General Acute Care Hospital
  • Mauston, WI
  • NPI 1568487411
  Care Compare affiliation

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

{
    "created_epoch": "1473811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626134400000",
    "number": "1396293890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 S PARK ST",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537151830",
            "telephone_number": "608-251-6100",
            "fax_number": "608-260-2976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 DEERFIELD DR",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535463557",
            "telephone_number": "608-314-3600",
            "fax_number": "608-314-3601"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "700 S Park St",
            "address_purpose": "LOCATION",
            "city": "Madison",
            "state": "WI",
            "postal_code": "537151830",
            "country_code": "US",
            "telephone_number": "608-251-6100",
            "fax_number": "608-260-2976",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GUNDERSON",
        "first_name": "KATHERINE",
        "middle_name": "E.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-14",
        "last_updated": "2021-07-13",
        "certification_date": "2021-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "3892-23",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1396293890",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kgunderson288629@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "kgunderson288629@direct-ehr-ssmhc.com",
            "address_1": "700 S Park St",
            "city": "Madison",
            "state": "WI",
            "country_code": "US",
            "postal_code": "537151830",
            "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": "700 S Park St",
            "city": "Madison",
            "state": "WI",
            "country_code": "US",
            "postal_code": "537151830",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KATHERINE",
            "last_name": "MIKKELSON",
            "middle_name": "E.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.