Michael Koroch, PA-C, ATC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

4106-23 Issued in WI

Practice address

333 Pine Ridge Blvd
Wausau, WI 54401-4102

Phone

(715) 847-2121

NPI assigned

Apr 23, 2009

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

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

Medicare enrollment (NPD)

Enrolled

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.

• Aspirus Wausau Hospital, Inc.

  • Clinic/Center
  • Wausau, WI
  • NPI 1922321140
  Medicare reassignment
• Aspirus Wausau Hospital, Inc.

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Wausau, WI
  • NPI 1225905102
  NPD
• Aspirus Wausau Hospital, Inc.

  • General Acute Care Hospital
  • Stevens Point, WI
  • NPI 1598375271
  NPD

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

{
    "created_epoch": "1240444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1508000357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 PINE RIDGE BLVD",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544014102",
            "telephone_number": "715-346-4570",
            "fax_number": "715-295-8938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 PINE RIDGE BLVD",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544014102",
            "telephone_number": "715-847-2121"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2050 4th Ave",
            "address_2": "040 HEC",
            "address_purpose": "LOCATION",
            "city": "Stevens Point",
            "state": "WI",
            "postal_code": "544811910",
            "country_code": "US",
            "telephone_number": "715-346-4570",
            "fax_number": "715-295-8938",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOROCH",
        "first_name": "MICHAEL",
        "credential": "PA-C, ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-04-23",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "WI",
            "license": "995-039",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "4106-23",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sheryl R Konig, MSW, APSW
• Lee Ann Kopecko
• Angela Kopetzky, RN
• Rebecca J Kopp, LPC-IT
• Taylor Korman, RN
• Kathleen Kostner-Rass, O.T.R.
• Kaylin Kostuchowski, OTR/L
• Brooke Elizabeth Kottke
• Courtney Koutnik
• Jennifer L. Kowalski, PT

• Physician Assistant in Wausau, WI
• Providers in Wausau, 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 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.