NPIMap

Individual provider Active NPI

Kara Vande Walle

  • Surgery Physician
  • Neenah, WI
National Provider Identifier
1679969323
Registry record updated Aug 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
67229-20 Issued in WI
Practice address
100 Theda Clark Medical PLZ Ste 400
Neenah, WI 54956-2763
Phone
(920) 725-4527
NPI assigned
Apr 9, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 5920 WI
Surgery Physician 208600000X ME156348 FL
Surgery Physician 208600000X 67229-20 WI Primary

Addresses

Primary practice location

100 Theda Clark Medical PLZ Ste 400
Neenah, WI 54956-2763

Mailing address

100 Theda Clark Medical PLZ Ste 400
Neenah, WI 54956-2763
Phone (659) 954-5000

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
I20231120000314 WI Practitioner - General Surgery 8123324274 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of Wisconsin School of Medicine, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Surgical Associates of Neenah, S.C.Group PAC ID 4486625258, 29 clinicians

Practice addresses (Care Compare)

100 Theda Clark Medical PLZ
Suite 400
Neenah, WI 54956-2763
Phone (920) 725-4527

Hospital & facility affiliations

  • Thedacare Regional Med Ctr - Neenah Hospital, Neenah, WI, CCN 520045
  • Thedacare Medical Center - Berlin Inc Hospital, Berlin, WI, CCN 521355

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy31
Hernia repair (minimally invasive)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux41
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
5920WIMDDentist
ME156348FLMDSurgery Physician
67229-20WIMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Euclid Hospital Cleveland Clinic Health System Current Accepting new patients
Surgical Associates of Neenah, S.C. Surgery CurrentSince Oct 26, 2023 Accepting new patients

Locations

225 Memorial Dr
Ste 2010
Berlin, WI 54923
Phone (920) 361-5975

100 Theda Clark Medical Plz
Neenah, WI 54956
Phone (920) 722-7747

100 Theda Clark Medical Plz
Ste 400
Neenah, WI 54956
Phone (414) 725-4527

Interoperability endpoints

  • Direct secure messaging: kvandewalle334196@direct.thedacare.org
  • Direct secure messaging: kvandewalle2309732@direct.ccf.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 8

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": "1428537600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692057600000",
    "number": "1679969323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 THEDA CLARK MEDICAL PLZ STE 400",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549562763",
            "telephone_number": "659-954-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 THEDA CLARK MEDICAL PLZ STE 400",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549562763",
            "telephone_number": "920-725-4527"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDE WALLE",
        "first_name": "KARA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-09",
        "last_updated": "2023-08-15",
        "certification_date": "2023-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WI",
            "license": "5920",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "FL",
            "license": "ME156348",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WI",
            "license": "67229-20",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Neenah, WI

Sources for this page

Verify at the official NPI Registry.