Mackenzie Rae Ketterhagen, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

Practice address

601 Gateway Blvd N
Chesterton, IN 46304-9658

Phone

(219) 921-1444

Fax

(219) 921-5303

NPI assigned

Sep 9, 2025

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

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

Specialty

Physician Assistant

Education

Other, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lakeshore Bone and Joint Institute, PCGroup PAC ID 3173500519, 82 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Lakeshore Bone & Joint Institute, PC

  • Specialist
  • Chesterton, IN
  • NPI 1508853953

  IN

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1757376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757376000000",
    "number": "1821979519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 GATEWAY BLVD N",
            "city": "CHESTERTON",
            "state": "IN",
            "postal_code": "463049658",
            "telephone_number": "219-921-1444",
            "fax_number": "219-921-5303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 GATEWAY BLVD N",
            "city": "CHESTERTON",
            "state": "IN",
            "postal_code": "463049658",
            "telephone_number": "219-921-1444",
            "fax_number": "219-921-5303"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 E 109th Ave",
            "address_purpose": "LOCATION",
            "city": "Crown Point",
            "state": "IN",
            "postal_code": "463077294",
            "country_code": "US",
            "telephone_number": "219-921-1444",
            "fax_number": "219-921-5303",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3691 Willowcreek Rd",
            "address_purpose": "LOCATION",
            "city": "Portage",
            "state": "IN",
            "postal_code": "463685080",
            "country_code": "US",
            "telephone_number": "219-921-1444",
            "fax_number": "219-921-5303",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "833 W Lincoln Hwy Ste 110E",
            "address_purpose": "LOCATION",
            "city": "Schererville",
            "state": "IN",
            "postal_code": "463754606",
            "country_code": "US",
            "telephone_number": "219-921-1444",
            "fax_number": "219-921-5303",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KETTERHAGEN",
        "first_name": "MACKENZIE",
        "middle_name": "RAE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-09-09",
        "last_updated": "2025-09-09",
        "certification_date": "2025-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas H Kay, M.D.
• Beth Georgia Keehn
• Lauren Therese Keilman, M.S., CC-SLP
• Emily A Kellogg
• Robbin Kern
• Melissa Kaye Khosla, DOT
• Kidworks
• Kidworks LLC
• Kidworks, LLC
• Alisa E Kilpatrick Small, MS, OTR/L

• Surgical Physician Assistant in Chesterton, IN
• Providers in Chesterton, IN by specialty
• Surgical Physician Assistant in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.