Individual provider Active NPI

Shanna Larochelle

  • Physician Assistant
  • Kewaunee, WI
National Provider Identifier
1508352311
Registry record updated Nov 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1020 Marquette Dr
Kewaunee, WI 54216-1782
Phone
(920) 388-0144
NPI assigned
Jul 4, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2023

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 Primary

Addresses

Primary practice location

1020 Marquette Dr
Kewaunee, WI 54216-1782

Mailing address

1020 Marquette Dr
Kewaunee, WI 54216-1782

Other practice location 1

323 S 18th Ave
Sturgeon Bay, WI 54235-1401
Phone (920) 743-5566

Other practice location 2

911 Green Bay Rd Ste 103
Sturgeon Bay, WI 54235-3814
Phone (920) 743-5566

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
I20180822002907 WI Practitioner - Physician Assistant 7416206586 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Door County Memorial HospitalGroup PAC ID 5395735088, 85 clinicians

Practice addresses (Care Compare)

1020 Marquette Dr
Kewaunee, WI 54216-1782
Phone (920) 496-4700

1843 Michigan St
Sturgeon Bay, WI 54235-1007
Phone (920) 746-1060

2502 S Ashland Ave
Green Bay, WI 54304-5252
Phone (920) 496-4700

2793 Lineville Rd
Green Bay, WI 54313-7152
Phone (920) 496-4700

3021 Voyager Dr
Green Bay, WI 54311-8303
Phone (920) 496-4700

323 S 18TH Ave
Sturgeon Bay, WI 54235-1401
Phone (920) 743-5566

3860 Monroe Rd
De Pere, WI 54115-8399
Phone (920) 496-4700

835 S Van Buren St
Green Bay, WI 54301-3526
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
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Prevea Clinic, Inc. CurrentSince Aug 1, 2018 Accepting new patients
Door County Memorial Hospital CurrentSince Jan 12, 2022 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis CurrentSince Aug 1, 2018 Accepting new patients
Door County Memorial Hospital CurrentSince Jan 12, 2022 Accepting new patients
St Nicholas Hospital-Sisters of the Third Order of St Francis CurrentSince Aug 1, 2018 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis CurrentSince Aug 1, 2018 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

2502 S Ashland Ave
Green Bay, WI 54304
Phone (920) 496-4750

1020 Marquette Dr
Kewaunee, WI 54216
Phone (920) 388-0144

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

911 Green Bay Rd
Ste 103
Sturgeon Bay, WI 54235
Phone (920) 743-5566

323 S 18th Ave
Sturgeon Bay, WI 54235
Phone (920) 743-5566

Organizations & group practices 8

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": "1530662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700179200000",
    "number": "1508352311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1020 MARQUETTE DR",
            "city": "KEWAUNEE",
            "state": "WI",
            "postal_code": "542161782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 MARQUETTE DR",
            "city": "KEWAUNEE",
            "state": "WI",
            "postal_code": "542161782",
            "telephone_number": "920-388-0144"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "323 S 18th Ave",
            "address_purpose": "LOCATION",
            "city": "Sturgeon Bay",
            "state": "WI",
            "postal_code": "542351401",
            "country_code": "US",
            "telephone_number": "920-743-5566",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "911 Green Bay Rd Ste 103",
            "address_purpose": "LOCATION",
            "city": "Sturgeon Bay",
            "state": "WI",
            "postal_code": "542353814",
            "country_code": "US",
            "telephone_number": "920-743-5566",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LAROCHELLE",
        "first_name": "SHANNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-04",
        "last_updated": "2023-11-17",
        "certification_date": "2023-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kewaunee, WI

Sources for this page

Verify at the official NPI Registry.