Individual provider Active NPI

Kelle J. Dahlke, PA

  • Physician Assistant
  • Menomonee Falls, WI
National Provider Identifier
1790079689
Registry record updated Jul 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2751 Issued in WI
Practice address
N84W16889 Menomonee Ave
Menomonee Falls, WI 53051-2810
Phone
(262) 251-7500
Fax
(262) 251-7128
NPI assigned
Jun 8, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2024

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 2751 WI Primary

Addresses

Primary practice location

N84W16889 Menomonee Ave
Menomonee Falls, WI 53051-2810

Mailing address

N84W16889 Menomonee Ave
Menomonee Falls, WI 53051-2810
Phone (414) 352-3100

Other identifiers 1

IdentifierTypeStateIssuer
100015628MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address kdahlke15209@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

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
I20110630000532 WI Practitioner - Physician Assistant 4880872407 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aurora Advanced Healthcare, Inc.Group PAC ID 3375625833, 1,107 clinicians

Practice addresses (Care Compare)

1032 E Sumner St
Hartford, WI 53027-1608
Phone (262) 673-2300

12203 N Corporate Pkwy
Mequon, WI 53092-3388
Phone (262) 387-8200

1640 E Sumner St
Hartford, WI 53027-2684
Phone (262) 670-4000

2900 W Oklahoma Ave
Milwaukee, WI 53215-4330
Phone (414) 649-6000

3003 W Good Hope Rd
Milwaukee, WI 53209-2042
Phone (414) 352-3100

36500 Aurora Dr
Summit, WI 53066-4899
Phone (262) 434-1000

W180N11070 River LN
Germantown, WI 53022-3109
Phone (262) 532-9700

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2751WIMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Advanced Healthcare Inc CurrentSince Jul 5, 2011 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Aug 29, 2017 Accepting new patients
Aurora Advanced Healthcare, Inc. CurrentSince Jul 5, 2011 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Aug 29, 2017 Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients

Locations

W180N11070 River Ln
Germantown, WI 53022
Phone (262) 532-9700

3003 W Good Hope Rd
Glendale, WI 53209
Phone (414) 352-3100

1640 E Sumner St
Hartford, WI 53027
Phone (262) 670-4000

N84W16889 Menomonee Ave
Menomonee Fls, WI 53051
Phone (262) 251-7500

12203 N Corporate Pkwy
Mequon, WI 53092
Phone (262) 387-8200

1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056

W231N1440 Corporate Ct
Waukesha, WI 53186
Phone (262) 896-6000

2999 N Mayfair Rd
Wauwatosa, WI 53222
Phone (414) 479-3737

Interoperability endpoints

  • Direct secure messaging: kdahlke15209@direct.myadvocateaurora.org

Organizations & group practices 6

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 2

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": "1307491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720742400000",
    "number": "1790079689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N84W16889 MENOMONEE AVE",
            "city": "MENOMONEE FALLS",
            "state": "WI",
            "postal_code": "530512810",
            "telephone_number": "414-352-3100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N84W16889 MENOMONEE AVE",
            "city": "MENOMONEE FALLS",
            "state": "WI",
            "postal_code": "530512810",
            "telephone_number": "262-251-7500",
            "fax_number": "262-251-7128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAHLKE",
        "first_name": "KELLE",
        "middle_name": "J.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-08",
        "last_updated": "2024-07-12",
        "certification_date": "2024-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "2751",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100015628",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kdahlke15209@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "N84W16889 Menomonee Ave",
            "city": "Menomonee Falls",
            "state": "WI",
            "country_code": "US",
            "postal_code": "530512810",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "N84W16889 Menomonee Ave",
            "city": "Menomonee Falls",
            "state": "WI",
            "country_code": "US",
            "postal_code": "530512810",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Menomonee Falls, WI

Sources for this page

Verify at the official NPI Registry.