Individual provider Active NPI

Joseph D Heckenkamp, PA

  • Physician Assistant
  • Ripon, WI
National Provider Identifier
1740378603
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2061 Issued in WI
Practice address
845 Parkside St
Ripon, WI 54971-8505
Phone
(920) 745-3500
Fax
(920) 745-7930
NPI assigned
Oct 10, 2006
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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 2061 WI Primary

Addresses

Primary practice location

845 Parkside St
Ripon, WI 54971-8505

Mailing address

420 E Division St
Fond Du Lac, WI 54935-4560
Phone (920) 926-8340

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
I20070105000172 WI Practitioner - Physician Assistant 1254331895 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Agnesian Healthcare IncGroup PAC ID 1658289624, 392 clinicians

Practice addresses (Care Compare)

360 S Mountin Dr
Mayville, WI 53050-1498
Phone (920) 387-2111

420 E Division St
Fond Du Lac, WI 54935-4560
Phone (920) 923-7400

430 E Division St
Fond Du Lac, WI 54935-4560
Phone (920) 929-2300

608 W Brown St
Waupun, WI 53963-1702
Phone (920) 324-6800

620 W Brown St
Waupun, WI 53963-1702
Phone (920) 324-6531

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2061WIMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Agnesian Healthcare Inc CurrentSince Jun 1, 2017 Accepting new patients
Agnesian Healthcare Inc CurrentSince Jun 1, 2017 Accepting new patients

Locations

420 E Division St
Fond du Lac, WI 54935
Phone (920) 923-7400

430 E Division St
Fond du Lac, WI 54935
Phone (920) 926-4200

360 S Mountin Dr
Mayville, WI 53050
Phone (920) 387-2111

835 Parkside St
Ripon, WI 54971
Phone (920) 745-3520

845 Parkside St
Ripon, WI 54971
Phone (920) 748-3101

933 Newbury St
Ripon, WI 54971
Phone (920) 748-0430

600 Fern St
Waupun, WI 53963
Phone (920) 251-3981

608 W Brown St
Waupun, WI 53963
Phone (920) 324-6800

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1740378603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 E DIVISION ST",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549354560",
            "telephone_number": "920-926-8340",
            "fax_number": "920-926-8370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "845 PARKSIDE ST",
            "city": "RIPON",
            "state": "WI",
            "postal_code": "549718505",
            "telephone_number": "920-745-3500",
            "fax_number": "920-745-7930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HECKENKAMP",
        "first_name": "JOSEPH",
        "middle_name": "D",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-10",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "2061",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ripon, WI

Sources for this page

Verify at the official NPI Registry.