NPIMap

Individual provider Active NPI

Kendra Niemuth, RN BSN

  • Nurse Practitioner
  • Seymour, WI
National Provider Identifier
1407384241
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
7736-33 Issued in WI
Practice address
958 Foote St
Seymour, WI 54165-1044
Phone
(920) 833-9896
NPI assigned
May 24, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 190067-30 WI
Nurse Practitioner 363L00000X 7736-33 WI Primary

Addresses

Primary practice location

958 Foote St
Seymour, WI 54165-1044

Mailing address

PO Box 19070
Green Bay, WI 54307-9070
Phone (920) 496-4700

Other practice location 1

940 S Saint Augustine St
Pulaski, WI 54162-9453
Phone (920) 822-5444

Other identifiers 1

IdentifierTypeStateIssuer
7736-33OtherWIAPNP LICENSE

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
I20170817004006 WI Practitioner - Nurse Practitioner 5597037002 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

958 Foote St
Seymour, WI 54165-1044
Phone (920) 496-4700

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.81 of 100Reported as apm
Quality
85.98
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Bachelor on Science - Nursing, Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
190067-30WIMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis CurrentSince Jul 17, 2017 Accepting new patients
Prevea Clinic, Inc. Current Accepting new patients
Prevea Clinic, Inc. CurrentSince Nov 29, 2017 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis CurrentSince Jul 17, 2017 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis Past Accepting new patients

Locations

1726 Shawano Ave
Green Bay, WI 54303
Phone (920) 432-6016

835 S Van Buren St
Green Bay, WI 54301
Phone (888) 901-7246

940 S Saint Augustine St
Pulaski, WI 54162
Phone (920) 272-1611

958 Foote St
Seymour, WI 54165
Phone (920) 833-7796

Organizations & group practices 5

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 6

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": "1495584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1407384241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19070",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543079070",
            "telephone_number": "920-496-4700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "958 FOOTE ST",
            "city": "SEYMOUR",
            "state": "WI",
            "postal_code": "541651044",
            "telephone_number": "920-833-9896"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "940 S Saint Augustine St",
            "address_purpose": "LOCATION",
            "city": "Pulaski",
            "state": "WI",
            "postal_code": "541629453",
            "country_code": "US",
            "telephone_number": "920-822-5444",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NIEMUTH",
        "first_name": "KENDRA",
        "name_prefix": "Mrs.",
        "credential": "RN BSN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-24",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WI",
            "license": "190067-30",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "7736-33",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "APNP LICENSE",
            "identifier": "7736-33",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Seymour, WI

Sources for this page

Verify at the official NPI Registry.