NPIMap

Individual provider Active NPI

Kelsey R Lauterbach, PA-C

  • Physician Assistant
  • Sheboygan, WI
National Provider Identifier
1447739032
Registry record updated Dec 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
4851-23 Issued in WI
Practice address
3113 Saemann Ave
Sheboygan, WI 53081-1957
Phone
(920) 496-4700
NPI assigned
Aug 14, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 4851-23 WI Primary

Addresses

Primary practice location

3113 Saemann Ave
Sheboygan, WI 53081-1957

Mailing address

N3094 Bates Rd
Cascade, WI 53011-1314
Phone (715) 966-5609

Other practice location 1

430 E Division St
Fond Du Lac, WI 54935-4560
Phone (920) 929-2300

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address krenn342042@direct-ehr-ssmhc.com Direct
FHIR URL https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ Other

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
I20190925000916 WI Practitioner - Physician Assistant 9032449657 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1411 N Taylor Dr
Sheboygan, WI 53081-3043
Phone (920) 457-4858

15 S 10TH St
Suite a
Oostburg, WI 53070-1370
Phone (920) 552-5046

3100 Superior Ave
Sheboygan, WI 53081-1948
Phone (920) 459-8300

3113 Saemann Ave
Sheboygan, WI 53081-1957
Phone (920) 496-4700

950 Woodlake Rd
Kohler, WI 53044-1348
Phone (920) 783-3150

PO Box
Suite 19070
Green Bay, WI 54307-9070

Hospital & facility affiliations

  • St Nicholas Hospital Hospital, Sheboygan, WI, CCN 520044
  • St Vincent Hospital Hospital, Green Bay, WI, CCN 520075

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
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
St Nicholas Hospital-Sisters of the Third Order of St Francis CurrentSince Dec 1, 2021 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis CurrentSince Dec 1, 2021 Accepting new patients
St. Nicholas Hospital-Sisters of the Third Order of St Francis CurrentSince Dec 1, 2021 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis CurrentSince Dec 1, 2021 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis Past Accepting new patients

Locations

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

3113 Saemann Ave
Sheboygan, WI 53081

3100 Superior Ave
Sheboygan, WI 53081
Phone (800) 472-6710

Organizations & group practices 6

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 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": "1534204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639526400000",
    "number": "1447739032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N3094 BATES RD",
            "city": "CASCADE",
            "state": "WI",
            "postal_code": "530111314",
            "telephone_number": "715-966-5609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3113 SAEMANN AVE",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "530811957",
            "telephone_number": "920-496-4700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "430 E Division St",
            "address_purpose": "LOCATION",
            "city": "Fond Du Lac",
            "state": "WI",
            "postal_code": "549354560",
            "country_code": "US",
            "telephone_number": "920-929-2300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LAUTERBACH",
        "first_name": "KELSEY",
        "middle_name": "R",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-14",
        "last_updated": "2021-12-15",
        "certification_date": "2021-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "4851-23",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "krenn342042@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "krenn342042@direct-ehr-ssmhc.com",
            "address_1": "430 E Division St",
            "city": "Fond Du Lac",
            "state": "WI",
            "country_code": "US",
            "postal_code": "549354560",
            "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": "430 E Division St",
            "city": "Fond Du Lac",
            "state": "WI",
            "country_code": "US",
            "postal_code": "549354560",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Sheboygan, WI

Sources for this page

Verify at the official NPI Registry.