Kellyn Jean Doerge, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2954-23 Issued in WI

Practice address

9200 West Wisconsin Ave
Clinical Cancer Center 5TH Floor
Milwaukee, WI 53226-3596

Phone

(414) 805-0820

Fax

(414) 805-0988

NPI assigned

Jun 26, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Ms. Kellyn J Boettcher Former name

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

Specialty

Physician Assistant

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Medical College of Wisconsin IncGroup PAC ID 2668384371, 2,092 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Froedtert Memorial Lutheran Hospital Hospital, Milwaukee, WI, CCN 520177

Merit-based Incentive Payment System (MIPS)

Final score

87.99 of 100Reported as group

Quality

82.81

Promoting interoperability

100

Improvement activities

40

Cost

77.15

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• The Medical College of Wisconsin, Inc.

  • Internal Medicine Physician
  • Milwaukee, WI
  • NPI 1699720086
  Medicare reassignment Care Compare group

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Froedtert Memorial Lutheran Hospital, Inc.

  • General Acute Care Hospital
  • Milwaukee, WI
  • NPI 1255334173
  Care Compare affiliation

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

{
    "created_epoch": "1340668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418169600000",
    "number": "1831453745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9200 WEST WISCONSIN AVE",
            "address_2": "CLINICAL CANCER CENTER 5TH FLOOR",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532263596",
            "telephone_number": "414-805-0820",
            "fax_number": "414-805-0988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9200 WEST WISCONSIN AVE",
            "address_2": "CLINICAL CANCER CENTER 5TH FLOOR",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532263596",
            "telephone_number": "414-805-0820",
            "fax_number": "414-805-0988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOERGE",
        "first_name": "KELLYN",
        "middle_name": "JEAN",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-26",
        "last_updated": "2014-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "2954-23",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1831453745",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MB2668549",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLYN",
            "last_name": "BOETTCHER",
            "middle_name": "J",
            "prefix": "MS.",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Cindy Goes Dodo, DDS; PHD
• Ashley Noel Doebert, DC
• Madeleine Katharina Doelker Berlin
• Allison Margaret Doerfer
• Karl William Doerfer, MD
• Stefan G Doerge, M.D.
• Aaron Lee Doering, MS, ATC
• Jodi Doering, APNP
• Brianna Doerr
• Heidi Rose Doerr, MSPT, OMPT

• Physician Assistant in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Physician Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2014; 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.