NPIMap

Individual provider Active NPI

Hannah Kerkhof, PA-C

  • Physician Assistant
  • Shawano, WI
National Provider Identifier
1780356691
Registry record updated Mar 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
100 County Road B
Shawano, WI 54166-7072
Phone
(715) 524-2161
Fax
(715) 916-3029
NPI assigned
Sep 29, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 6, 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

100 County Road B
Shawano, WI 54166-7072

Mailing address

100 County Road B
Shawano, WI 54166-7072
Phone (715) 524-2161

Other practice location 1

370 S Main St
Clintonville, WI 54929-1632
Phone (715) 823-5161

Other practice location 2

3475 S Alpine Rd
Rockford, IL 61109-2604
Phone (815) 874-8000

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
I20230302002974 WI Practitioner - Physician Assistant 7012308521 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Thedacare, IncorporatedGroup PAC ID 1759294887, 654 clinicians

Practice addresses (Care Compare)

100 County Rd B
Shawano, WI 54166-7072
Phone (715) 526-2111

110 Cedar St
Tigerton, WI 54486-9527
Phone (715) 535-2115

2500 E Capital Dr
Appleton, WI 54911-8735

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

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
7193WIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Thedacare, Incorporated CurrentSince Mar 1, 2023 Accepting new patients
Thedacare Medical Center - Shawano, Inc. CurrentSince Mar 1, 2023 Accepting new patients
Thedacare, Incorporated CurrentSince Mar 1, 2023 Accepting new patients
Thedacare Medical Center - Shawano, Inc. CurrentSince Mar 1, 2023 Accepting new patients
Thedacare Medical Center - Berlin, Inc. Past Accepting new patients

Locations

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

370 S Main St
Clintonville, WI 54929
Phone (715) 526-7370

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

100 Cty Road B
Shawano, WI 54166
Phone (715) 524-2161

Interoperability endpoints

  • Direct secure messaging: hkerkhof329625@direct.thedacare.org

Organizations & group practices 5

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 6

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": "1632873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678060800000",
    "number": "1780356691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 COUNTY ROAD B",
            "city": "SHAWANO",
            "state": "WI",
            "postal_code": "541667072",
            "telephone_number": "715-524-2161",
            "fax_number": "715-916-3029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 COUNTY ROAD B",
            "city": "SHAWANO",
            "state": "WI",
            "postal_code": "541667072",
            "telephone_number": "715-524-2161",
            "fax_number": "715-916-3029"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "370 S Main St",
            "address_purpose": "LOCATION",
            "city": "Clintonville",
            "state": "WI",
            "postal_code": "549291632",
            "country_code": "US",
            "telephone_number": "715-823-5161",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3475 S Alpine Rd",
            "address_purpose": "LOCATION",
            "city": "Rockford",
            "state": "IL",
            "postal_code": "611092604",
            "country_code": "US",
            "telephone_number": "815-874-8000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KERKHOF",
        "first_name": "HANNAH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-29",
        "last_updated": "2023-03-06",
        "certification_date": "2023-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shawano, WI

Sources for this page

Verify at the official NPI Registry.