Shannon L Koss, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1604 Issued in WI

Practice address

1531 S Madison St
Appleton, WI 54915

Phone

(920) 996-3700

NPI assigned

Sep 27, 2006

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 1

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, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bellin Memorial Hospital IncGroup PAC ID 8820900749, 685 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Bellin Memorial Hospital Hospital, Green Bay, WI, CCN 520049
• Thedacare Regional Medical Center - Appleton Inc Hospital, Appleton, WI, CCN 520160

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: skoss304464@direct.thedacare.org
• Direct secure messaging: skoss925707@direct.emplifyhealth.org

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.

• Bellin Memorial Hospital Inc

  • Rural Health Clinic/Center
  • Algoma, WI
  • NPI 1609838473
  Medicare reassignment Care Compare group
• Bellin Memorial Hospital Inc

  • Family Medicine Physician
  • Green Bay, WI
  • NPI 1033172390
  NPD
• Bellin Memorial Hospital Inc

  • Family Medicine Physician
  • Pulaski, WI
  • NPI 1609838390
  NPD

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

• Bellin Memorial Hospital Inc.

  • General Acute Care Hospital
  • Green Bay, WI
  • NPI 1891740585
  Care Compare affiliation
• Thedacare Regional Medical Center - Appleton, Inc

  • General Acute Care Hospital
  • Appleton, WI
  • NPI 1740920909
  Care Compare affiliation
• Thedacare Regional Medical Center - Appleton, Inc.

  • General Acute Care Hospital
  • Appleton, WI
  • NPI 1497119218
  Care Compare affiliation
• Thedacare Regional Medical Center - Appleton, Inc.

  • General Acute Care Hospital
  • Appleton, WI
  • NPI 1689038408
  Care Compare affiliation
• Thedacare Regional Medical Center - Appleton, Inc.

  • General Acute Care Hospital
  • Appleton, WI
  • NPI 1831773589
  Care Compare affiliation
• Thedacare Regional Medical Center - Appleton, Inc.

  • General Acute Care Hospital
  • Appleton, WI
  • NPI 1902832306
  Care Compare affiliation
• Thedacare Regional Medical Center - Appleton, Inc.

  • General Acute Care Hospital
  • Fond Du Lac, WI
  • NPI 1912721002
  Care Compare affiliation
• Thedacare Regional Medical Center - Appleton, Inc.

  • General Acute Care Hospital
  • Oshkosh, WI
  • NPI 1912880329
  Care Compare affiliation

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642464000000",
    "number": "1861583007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22487",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543052487",
            "telephone_number": "920-445-7222",
            "fax_number": "920-445-7289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1531 S MADISON ST",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "54915",
            "telephone_number": "920-996-3700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOSS",
        "first_name": "SHANNON",
        "middle_name": "L",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-27",
        "last_updated": "2022-01-18",
        "certification_date": "2022-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "1604",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41978400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Casie L Korth, PT
• Kathryn Ann Korth, O.D., F.A.A.O.
• Bonnie Anne Korytkowski, DO
• Leslie Koser
• Pamela A Kososki, LA.C, LMT
• Amanda Anne Kossak, M.D.
• Karyne Kosterman, SAC-IT
• Katelyn Rose Kotkosky, LPC
• Rochelle A Kottke, LCSW
• Brenda Kovach, R.PH.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 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.

Verify at the official NPI Registry.