Active NPI
Kevyn Alexis Janicek Wollenberg
- Physician Assistant
- New Richmond, WI
National Provider Identifier
1851977854
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 5868-23
- Practice address
- 535 Hospital Rd
New Richmond, WI 54017-1449 - Phone
- (715) 243-2600
- NPI assigned
- Mar 20, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 5868-23 | WI | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
535 Hospital Rd
New Richmond, WI 54017-1449
Mailing address
1330 214TH Ave
New Richmond, WI 54017-1068
Phone (440) 785-4701
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
535 Hospital Rd
New Richmond, WI 54017-1449
Phone (715) 243-2600
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5868-23 | WI | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Westfields Hospital, Inc. | Current | Accepting new patients |
Locations
535 Hospital Rd
New Richmond, WI 54017
Phone (651) 292-2013
Organizations & group practices 1
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.
-
- Critical Access Hospital
- New Richmond, WI
- NPI 1881640183
Hospital & facility affiliations 16
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Critical Access Hospital
- Amery, WI
- NPI 1093763518
-
- Rural Health Clinic/Center
- Clear Lake, WI
- NPI 1366878449
Hospital
-
- Rural Health Clinic/Center
- Turtle Lake, WI
- NPI 1538384466
Hospital
-
- Critical Access Hospital
- New Richmond, WI
- NPI 1881640183
-
- General Acute Care Hospital
- Stillwater, MN
- NPI 1538138003
-
- Home Health Agency
- Oak Park Heights, MN
- NPI 1174522239
-
- General Acute Care Hospital
- Woodbury, MN
- NPI 1104681105
-
- General Acute Care Hospital
- Saint Paul, MN
- NPI 1306873872
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1616198400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1660867200000",
"number": "1851977854",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1330 214TH AVE",
"city": "NEW RICHMOND",
"state": "WI",
"postal_code": "540171068",
"telephone_number": "440-785-4701"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "535 HOSPITAL RD",
"city": "NEW RICHMOND",
"state": "WI",
"postal_code": "540171449",
"telephone_number": "715-243-2600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOLLENBERG",
"first_name": "KEVYN",
"middle_name": "ALEXIS JANICEK",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-03-20",
"last_updated": "2022-08-19",
"certification_date": "2022-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WI",
"license": "5868-23",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New Richmond, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2022; 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.