Roger A Handtke, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

63316 Issued in WI

Practice address

Essentia Health Spooner Clinic
1180 Chandler Drive
Spooner, WI 54801

Phone

(715) 635-2151

NPI assigned

Jul 5, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Lac Courte Oreilles Governing

  • Clinic/Center
  • Hayward, WI
  • NPI 1194830208

  WI

  Medicare reassignment NPD

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1396776589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13380 W TREPANIA RD",
            "city": "HAYWARD",
            "state": "WI",
            "postal_code": "548432186",
            "telephone_number": "715-638-5100",
            "fax_number": "715-634-6107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ESSENTIA HEALTH SPOONER CLINIC",
            "address_2": "1180 CHANDLER DRIVE",
            "city": "SPOONER",
            "state": "WI",
            "postal_code": "54801",
            "telephone_number": "715-635-2151"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13380 W Trepania Rd",
            "address_purpose": "LOCATION",
            "city": "Hayward",
            "state": "WI",
            "postal_code": "548432186",
            "country_code": "US",
            "telephone_number": "715-638-5100",
            "fax_number": "715-634-6107",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HANDTKE",
        "first_name": "ROGER",
        "middle_name": "A",
        "name_prefix": "Mr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-05",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "02001222A",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "63316",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100209300",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brian W Gaskill, DO
• Lauren Geier, ATC
• Ashley L Goffin
• Greenfield Physical Therapy & Sports Medicine LLC
• Amy M Greenfield, PT
• Trina Sue Hanson, COTA
• Parker Hewes, DC
• Travis W Hinze, PH.D.
• Heather Allison Holm, APRN, CNP
• David Hopp, RPH

• All providers in Spooner, WI
• Family Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.