Individual provider Active NPI

Amanda Marie Kassner, PA-C

  • Physician Assistant
  • Sturgeon Bay, WI
National Provider Identifier
1841875994
Registry record updated Apr 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5466-23 Issued in WI
Practice address
323 S 18TH Ave
Sturgeon Bay, WI 54235-1401
Phone
(920) 746-0510
NPI assigned
Mar 10, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 3, 2025

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 5466-23 WI Primary

Addresses

Primary practice location

323 S 18TH Ave
Sturgeon Bay, WI 54235-1401

Mailing address

323 S 18TH Ave
Sturgeon Bay, WI 54235-1401
Phone (920) 743-5566

Other practice location 1

815 Jefferson St
Algoma, WI 54201-1733
Phone (920) 487-3496

Other practice location 2

2345 Canterbury Ln
Sister Bay, WI 54234-5602
Phone (920) 868-3511

Other identifiers 1

IdentifierTypeStateIssuer
100242585MedicaidWI

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
I20230701000414 WI Practitioner - Physician Assistant 8628437084 Reassigns benefits to 2 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
Door County Memorial HospitalGroup PAC ID 5395735088, 85 clinicians

Practice addresses (Care Compare)

323 S 18TH Ave
Sturgeon Bay, WI 54235-1401
Phone (920) 743-5566

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5466-23WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Door County Memorial Hospital CurrentSince Jul 1, 2024 Accepting new patients
Door County Memorial Hospital CurrentSince Jul 1, 2024 Accepting new patients

Locations

815 Jefferson St
Algoma, WI 54201
Phone (920) 431-1850

2345 Canterbury Ln
Sister Bay, WI 54234
Phone (920) 380-9890

323 S 18th Ave
Sturgeon Bay, WI 54235
Phone (920) 743-5566

Organizations & group practices 2

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": "1615334400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743638400000",
    "number": "1841875994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "323 S 18TH AVE",
            "city": "STURGEON BAY",
            "state": "WI",
            "postal_code": "542351401",
            "telephone_number": "920-743-5566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "323 S 18TH AVE",
            "city": "STURGEON BAY",
            "state": "WI",
            "postal_code": "542351401",
            "telephone_number": "920-746-0510"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "815 Jefferson St",
            "address_purpose": "LOCATION",
            "city": "Algoma",
            "state": "WI",
            "postal_code": "542011733",
            "country_code": "US",
            "telephone_number": "920-487-3496",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2345 Canterbury Ln",
            "address_purpose": "LOCATION",
            "city": "Sister Bay",
            "state": "WI",
            "postal_code": "542345602",
            "country_code": "US",
            "telephone_number": "920-868-3511",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KASSNER",
        "first_name": "AMANDA",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-03-10",
        "last_updated": "2025-04-03",
        "certification_date": "2025-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "5466-23",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100242585",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sturgeon Bay, WI

Sources for this page

Verify at the official NPI Registry.