NPIMap

Individual provider Active NPI

Kayla Michelle Poncek

  • Nurse Practitioner
  • Rhinelander, WI
National Provider Identifier
1497393250
Registry record updated Dec 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
9792 Issued in WI
Practice address
1630 Chippewa Dr
Rhinelander, WI 54501-9503
Phone
(715) 361-5480
NPI assigned
Dec 11, 2019
Last updated
Dec 11, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 9792 WI Primary

Addresses

Primary practice location

1630 Chippewa Dr
Rhinelander, WI 54501-9503

Mailing address

3564 Driscoll Rd Apt 12
Rhinelander, WI 54501-3675

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
I20200225002888 WI Practitioner - Nurse Practitioner 1951738293 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Surgical Associates, S.C.Group PAC ID 3072400019, 26 clinicians
Aspirus Rhinelander and Tomahawk Hospitals and Clinics, Inc.Group PAC ID 9335059856, shared by 17 NPIs, 566 clinicians

Practice addresses (Care Compare)

2400 Pine Ridge Blvd
Wausau, WI 54401-7803
Phone (715) 847-2022

824 Illinois Ave
Stevens Point, WI 54481-3112
Phone (715) 344-1600

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
97.56 of 100Reported as group
Quality
90.89
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
9792WIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Surgical Associates, S.C. CurrentSince Aug 1, 2021 Accepting new patients

Locations

112 E 5th Ave
Antigo, WI 54409
Phone (715) 623-2331

2400 Pine Ridge Blvd
Wausau, WI 54401
Phone (715) 847-2022

2606 Stewart Ave
Ste 100
Wausau, WI 54401
Phone (715) 847-0000

Interoperability endpoints

  • Direct secure messaging: kponcek152987@direct.aspirus.org

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1576022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576022400000",
    "number": "1497393250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3564 DRISCOLL RD APT 12",
            "city": "RHINELANDER",
            "state": "WI",
            "postal_code": "545013675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1630 CHIPPEWA DR",
            "city": "RHINELANDER",
            "state": "WI",
            "postal_code": "545019503",
            "telephone_number": "715-361-5480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PONCEK",
        "first_name": "KAYLA",
        "middle_name": "MICHELLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-11",
        "last_updated": "2019-12-11",
        "certification_date": "2019-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "9792",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rhinelander, WI

Sources for this page

Verify at the official NPI Registry.