Individual provider Active NPI

Katie M Komro, NP-C

  • Family Nurse Practitioner
  • Altoona, WI
National Provider Identifier
1508113457
Registry record updated Jun 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
5017-33 Issued in WI
Practice address
1200 Oakleaf Way Ste a
Altoona, WI 54720-2217
Phone
(715) 832-1400
Fax
(715) 832-4187
NPI assigned
Aug 9, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 5017-33 WI Primary

Addresses

Primary practice location

1200 Oakleaf Way Ste a
Altoona, WI 54720-2217

Mailing address

1200 Oakleaf Way Ste a
Altoona, WI 54720-2217
Phone (715) 832-1400

Other identifiers 1

IdentifierTypeStateIssuer
1508113457MedicaidWI

Other names 1

  • Katie M Holden Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ajcrow@cvosm.gwaydirect.com

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20121027000010 WI Practitioner - Nurse Practitioner 6709036742 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Chippewa Valley Orthopedics and Sports Medicine Clinic SCGroup PAC ID 7618948399, 30 clinicians

Practice addresses (Care Compare)

1200 Oakleaf Way
A
Altoona, WI 54720-2245
Phone (715) 832-1400

Hospital & facility affiliations

  • Oakleaf Surgical Hospital Hospital, Altoona, WI, CCN 520196

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Chippewa Valley Orthopedics and Sports Medicine Clinic SC CurrentSince Feb 16, 2015 Accepting new patients
Chippewa Valley Orthopedics and Sports Medicine Clinic, SC CurrentSince Feb 16, 2015 Accepting new patients
Medical X-Ray Consultants, LTD Past Accepting new patients

Locations

1200 Oakleaf Way
Ste A
Altoona, WI 54720
Phone (800) 322-1747

1200 Oakleaf Way
Altoona, WI 54720
Phone (715) 839-1778

757 Lakeland Dr
Ste B
Chippewa Falls, WI 54729
Phone (715) 723-5989

2200 Cedar Crest Dr
Ste A
Rice Lake, WI 54868
Phone (715) 455-0408

113 4th Ave
Shell Lake, WI 54871
Phone (715) 468-7833

Organizations & group practices 3

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 1

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": "1344470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780617600000",
    "number": "1508113457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 OAKLEAF WAY STE A",
            "city": "ALTOONA",
            "state": "WI",
            "postal_code": "547202217",
            "telephone_number": "715-832-1400",
            "fax_number": "715-832-4187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 OAKLEAF WAY STE A",
            "city": "ALTOONA",
            "state": "WI",
            "postal_code": "547202217",
            "telephone_number": "715-832-1400",
            "fax_number": "715-832-4187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOMRO",
        "first_name": "KATIE",
        "middle_name": "M",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-09",
        "last_updated": "2026-06-05",
        "certification_date": "2026-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "5017-33",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1508113457",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ajcrow@cvosm.gwaydirect.com",
            "affiliation": "N",
            "address_1": "1200 Oakleaf Way",
            "address_2": "Suite A",
            "city": "Altoona",
            "state": "WI",
            "country_code": "US",
            "postal_code": "547202245",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KATIE",
            "last_name": "HOLDEN",
            "middle_name": "M",
            "credential": "NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Altoona, WI

Sources for this page

Verify at the official NPI Registry.