NPIMap

Individual provider Active NPI

Amber Dee Runnoe, PA-C

  • Physician Assistant
  • Appleton, WI
National Provider Identifier
1861917098
Registry record updated Sep 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
4143-23 Issued in WI
Practice address
2500 E Capitol Dr
Appleton, WI 54911-8735
Phone
(920) 364-3600
Fax
(920) 364-3900
NPI assigned
Aug 9, 2017
Last updated
Sep 26, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2019

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 4143-23 WI Primary

Addresses

Primary practice location

2500 E Capitol Dr
Appleton, WI 54911-8735

Mailing address

122 E College Ave
Appleton, WI 54911-5794
Phone (920) 996-3264

Other practice location 1

1818 N Meade St Ste N347
Appleton, WI 54911-3454
Phone (920) 731-8900

Other names 1

  • Amber Dee Ahlquist Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171009002504 WI Practitioner - Physician Assistant 5395010839 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Wisconsin School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Thedacare, IncorporatedGroup PAC ID 1759294887, 654 clinicians

Practice addresses (Care Compare)

100 County Rd B
Shawano, WI 54166-7072
Phone (920) 735-7300

130 2ND St
Neenah, WI 54956-2883
Phone (920) 725-0077

2500 E Capital Dr
Appleton, WI 54911-8735

3 Neenah Ctr
Neenah, WI 54956-3070

4480 W Spencer St
Appleton, WI 54915
Phone (920) 738-4800

600 N Westhaven Dr
Oshkosh, WI 54904-6926
Phone (920) 725-0077

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4143-23WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Thedacare, Incorporated CurrentSince Aug 14, 2017 Accepting new patients
Thedacare, Incorporated CurrentSince Aug 14, 2017 Accepting new patients
Thedacare Medical Center - Berlin, Inc. Past Accepting new patients

Locations

122 E College Ave
Appleton, WI 54911
Phone (920) 996-3264

1818 N Meade St
Appleton, WI 54911
Phone (920) 731-4101

1818 N Meade St
Ste N347
Appleton, WI 54911
Phone (920) 225-1449

2500 E Capitol Dr
Appleton, WI 54911
Phone (920) 738-4600

4480 W Spencer St
Appleton, WI 54914
Phone (920) 738-4800

225 Memorial Dr
Berlin, WI 54923
Phone (920) 361-1313

130 2nd St
Neenah, WI 54956
Phone (920) 729-2063

1405 Mill St
New London, WI 54961
Phone (920) 531-2000

600 N Westhaven Dr
Oshkosh, WI 54904
Phone (920) 237-5000

800 Riverside Dr
Waupaca, WI 54981
Phone (715) 258-1000

Interoperability endpoints

  • Direct secure messaging: arunnoe173032@direct.thedacare.org

Organizations & group practices 3

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 11

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": "1502236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569456000000",
    "number": "1861917098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 E COLLEGE AVE",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549115794",
            "telephone_number": "920-996-3264",
            "fax_number": "920-830-5970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 E CAPITOL DR",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549118735",
            "telephone_number": "920-364-3600",
            "fax_number": "920-364-3900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1818 N Meade St Ste N347",
            "address_purpose": "LOCATION",
            "city": "Appleton",
            "state": "WI",
            "postal_code": "549113454",
            "country_code": "US",
            "telephone_number": "920-731-8900",
            "fax_number": "920-225-1429",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUNNOE",
        "first_name": "AMBER",
        "middle_name": "DEE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-09",
        "last_updated": "2019-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "4143-23",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMBER",
            "last_name": "AHLQUIST",
            "middle_name": "DEE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Appleton, WI

Sources for this page

Verify at the official NPI Registry.