Rebecca L Ketterhagen, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

4227 Issued in WI

Practice address

1726 Shawano Ave
Green Bay, WI 54303-3216

Phone

(920) 429-1700

Fax

(920) 830-5970

NPI assigned

Oct 19, 2017

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 names 1

• Rebecca L Mills 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, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

St Vincent Hospital-Hospital Sisters-Third Order of St FrancisGroup PAC ID 5799694675, 593 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Marys Hospital Medical Ctr Hospital, Green Bay, WI, CCN 520097
• St Vincent Hospital Hospital, Green Bay, WI, CCN 520075
• Door County Medical Center Hospital, Sturgeon Bay, WI, CCN 521358

Merit-based Incentive Payment System (MIPS)

Final score

94.81 of 100Reported as apm

Quality

85.98

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• St Vincent Hospital-Hospital Sisters-Third Order of St Francis

  • General Practice Physician
  • Green Bay, WI
  • NPI 1285613638
  Medicare reassignment Care Compare group NPD
• St Vincent Hospital-Hospital Sisters-Third Order of St Francis

  • Durable Medical Equipment & Medical Supplies
  • Green Bay, WI
  • NPI 1245042530
  NPD
• St Vincent Hospital-Hospital Sisters-Third Order of St Francis

  • Gynecologic Oncology Physician
  • Green Bay, WI
  • NPI 1316991169
  NPD (past)

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

• Door County Memorial Hospital

  • Critical Access Hospital
  • Sturgeon Bay, WI
  • NPI 1093743874
  Care Compare affiliation
• Door County Memorial Hospital

  • Clinical Medical Laboratory
  • Sturgeon Bay, WI
  • NPI 1811090285

  Hospital

  Care Compare affiliation
• St Mary'S Hospital Medical Center of Green Bay Inc.-Hospital Sisters

  • General Acute Care Hospital
  • Green Bay, WI
  • NPI 1649246877
  Care Compare affiliation
• St Vincent Hospital-Hospital Sisters-Third Order of St Francis

  • General Acute Care Hospital
  • Green Bay, WI
  • NPI 1114908001
  Care Compare affiliation
• St. Vincent Hospital-Hospital Sisters-Third Order of St Francis

  • Hematology & Oncology Physician
  • Sheboygan, WI
  • NPI 1831784636

  Hospital

  Care Compare affiliation
• St. Vincent Hospital-Hospital Sisters-Third Order of St. Francis

  • Hematology & Oncology Physician
  • Green Bay, WI
  • NPI 1184004236

  Hospital

  Care Compare affiliation
• St. Vincent Hospital-Hospital Sisters-Third Order of St. Francis

  • Hematology & Oncology Physician
  • Oconto Falls, WI
  • NPI 1750760740

  Hospital

  Care Compare affiliation
• St. Vincent Hospital-Hospital Sisters-Third Order of St. Francis

  • Hematology & Oncology Physician
  • Sturgeon Bay, WI
  • NPI 1760861751

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1508371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647993600000",
    "number": "1871004655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1726 SHAWANO AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543033216",
            "telephone_number": "920-429-1700",
            "fax_number": "920-830-5970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1726 SHAWANO AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543033216",
            "telephone_number": "920-429-1700",
            "fax_number": "920-830-5970"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 County Road B",
            "address_purpose": "LOCATION",
            "city": "Shawano",
            "state": "WI",
            "postal_code": "54166",
            "country_code": "US",
            "telephone_number": "715-524-2161",
            "fax_number": "715-524-8164",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KETTERHAGEN",
        "first_name": "REBECCA",
        "middle_name": "L",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-19",
        "last_updated": "2022-03-23",
        "certification_date": "2022-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "4227",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "REBECCA",
            "last_name": "MILLS",
            "middle_name": "L",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Physician Assistant in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Physician Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 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.