Individual provider Active NPI

Kristina Kochanova, PHD

  • Clinical Child & Adolescent Psychologist
  • Marshfield, WI
National Provider Identifier
1912483074
Registry record updated Mar 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
License
5066 Issued in WI
Practice address
1000 N Oak Ave
Marshfield, WI 54449-5702
Phone
(715) 387-5559
NPI assigned
Jul 12, 2018
Last updated
Mar 13, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 13, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 5066 WI
Clinical Child & Adolescent Psychologist 103TC2200X 5066 WI Primary

Addresses

Primary practice location

1000 N Oak Ave
Marshfield, WI 54449-5702

Mailing address

1000 N Oak Ave
Marshfield, WI 54449-5702

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address him@marshfieldclinichealthsystem.cernerdirect.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, IL2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240325000995 WI Practitioner - Psychiatry 6002253234 Reassigns benefits to 9 organizations
I20240905002584 IL Practitioner - Clinical Psychologist 6002253234 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MCHS Hospitals IncGroup PAC ID 5698071173, 1,195 clinicians

Practice addresses (Care Compare)

Johnsburg, IL 60051
Phone (715) 387-5211

1000 N Oak Ave
Marshfield, WI 54449-5703
Phone (715) 387-5511

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
5066WIMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeview Medical Center Inc of Rice Lake Multi-Specialty CurrentSince Feb 12, 2024 Accepting new patients
MCHS Hospitals Inc Multi-Specialty CurrentSince Aug 29, 2024 Accepting new patients
Flambeau Hospital Inc Multi-Specialty Current Accepting new patients
Beaver Dam Community Hospitals Inc CurrentSince Feb 12, 2024 Accepting new patients
MCHS Hospitals Inc Multi-Specialty CurrentSince Feb 12, 2024 Accepting new patients
Memorial Hospital Inc Multi-Specialty CurrentSince Feb 12, 2024 Accepting new patients
MCHS Hospitals Inc CurrentSince Feb 12, 2024 Accepting new patients
Flambeau Hospital Inc Multi-Specialty CurrentSince Feb 12, 2024 Accepting new patients
Lakeview Medical Center Inc of Rice Lake CurrentSince Feb 12, 2024 Accepting new patients
Marshfield Clinic Inc Multi-Specialty CurrentSince Feb 12, 2024 Accepting new patients
MCHS Hospitals Inc Multi-Specialty Current Accepting new patients
Beaver Dam Community Hospitals Inc Multi-Specialty CurrentSince Feb 12, 2024 Accepting new patients

Locations

705 S University Ave
Beaver Dam, WI 53916
Phone (920) 885-6090

3501 Golf Rd
Eau Claire, WI 54701
Phone (715) 858-4200

1000 N Oak Ave
Marshfield, WI 54449
Phone (715) 387-5111

1102 S Center Ave
Merrill, WI 54452
Phone (715) 536-3399

N3708 River Ave
Neillsville, WI 54456
Phone (715) 743-3101

1700 W Stout St
Rice Lake, WI 54868
Phone (715) 236-6133

Interoperability endpoints

  • Direct secure messaging: him@marshfieldclinichealthsystem.cernerdirect.com

Organizations & group practices 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1531353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710288000000",
    "number": "1912483074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 N OAK AVE",
            "city": "MARSHFIELD",
            "state": "WI",
            "postal_code": "544495702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 N OAK AVE",
            "city": "MARSHFIELD",
            "state": "WI",
            "postal_code": "544495702",
            "telephone_number": "715-387-5559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOCHANOVA",
        "first_name": "KRISTINA",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-07-12",
        "last_updated": "2024-03-13",
        "certification_date": "2024-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WI",
            "license": "5066",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "WI",
            "license": "5066",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "him@marshfieldclinichealthsystem.cernerdirect.com",
            "affiliation": "N",
            "address_1": "1000 N Oak Ave",
            "city": "Marshfield",
            "state": "WI",
            "country_code": "US",
            "postal_code": "544495702",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Marshfield, WI

Sources for this page

Verify at the official NPI Registry.