NPIMap

Individual provider Active NPI

Victoria Robyn Lois, PA-C

  • Physician Assistant
  • Wild Rose, WI
National Provider Identifier
1639664642
Registry record updated Dec 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
4393 Issued in WI
Practice address
701 Grove Ave
Wild Rose, WI 54984-6901
Phone
(920) 622-5560
NPI assigned
Jun 22, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 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 4393 WI Primary

Addresses

Primary practice location

701 Grove Ave
Wild Rose, WI 54984-6901

Mailing address

701 Grove Ave
Wild Rose, WI 54984-6901
Phone (920) 622-5560

Other names 1

  • Victoria Robyn Intine Former name

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
I20180910000849 WI Practitioner - Physician Assistant 0749530913 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Thedacare, IncorporatedGroup PAC ID 1759294887, 654 clinicians

Practice addresses (Care Compare)

225 Memorial Dr
Berlin, WI 54923-1243

3 Neenah Ctr
Neenah, WI 54956-3070

3925 N Gateway Dr
Appleton, WI 54913-7863
Phone (820) 702-6477

4480 W Spencer St
Appleton, WI 54915
Phone (920) 738-4800

701 Grove Ave
Wild Rose, WI 54984-6901
Phone (920) 622-5560

N2934 State Rd
22 FL 1
Wautoma, WI 54982-5267
Phone (920) 361-6330

Hospital & facility affiliations

  • Thedacare at Home Home health agency, Appleton, WI, CCN 527010
  • Aveanna Home Health Home health agency, Waupaca, WI, CCN 527122
  • Thedacare at Home Hospice, Appleton, WI, CCN 521504
  • Thedacare Medical Center - Wild Rose Hospital, Wild Rose, WI, CCN 521303
  • Thedacare Medical Center - Berlin Inc Hospital, Berlin, WI, CCN 521355
  • Thedacare Medical Center-Waupaca Hospital, Waupaca, WI, CCN 521334
  • Thedacare Regional Med Ctr - Neenah Hospital, Neenah, WI, CCN 520045
  • Thedacare Regional Medical Center - Appleton Inc Hospital, Appleton, WI, CCN 520160

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Thedacare, Incorporated CurrentSince Jul 24, 2018 Accepting new patients
Thedacare Medical Center - Berlin, Inc. Past Accepting new patients

Locations

4480 W Spencer St
Appleton, WI 54914
Phone (920) 738-4800

225 Memorial Dr
Berlin, WI 54923
Phone (920) 361-1313

3 Neenah Ctr
Neenah, WI 54956
Phone (920) 454-4229

1405 Mill St
New London, WI 54961
Phone (920) 531-2000

701 Grove Ave
Wild Rose, WI 54984
Phone (920) 361-5340

Interoperability endpoints

  • Direct secure messaging: vintine189121@direct.thedacare.org

Organizations & group practices 2

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 21

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

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1529625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640044800000",
    "number": "1639664642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 GROVE AVE",
            "city": "WILD ROSE",
            "state": "WI",
            "postal_code": "549846901",
            "telephone_number": "920-622-5560",
            "fax_number": "920-662-6021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 GROVE AVE",
            "city": "WILD ROSE",
            "state": "WI",
            "postal_code": "549846901",
            "telephone_number": "920-622-5560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOIS",
        "first_name": "VICTORIA",
        "middle_name": "ROBYN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-22",
        "last_updated": "2021-12-21",
        "certification_date": "2021-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "4393",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "VICTORIA",
            "last_name": "INTINE",
            "middle_name": "ROBYN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Wild Rose, WI

Sources for this page

Verify at the official NPI Registry.