NPIMap

Individual provider Active NPI

Teasha L Kaepernick, PA

  • Physician Assistant
  • New London, WI
National Provider Identifier
1922014406
Registry record updated Jul 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2038 Issued in WI
Practice address
1405 Mill St
New London, WI 54961-2155
Phone
(920) 531-2291
Fax
(920) 531-2207
NPI assigned
Aug 1, 2006
Sex
Female
Sole proprietor
No

Organizations & group practices 4

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.

Hospital & facility affiliations 10

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

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

122 E College Ave
Appleton, WI 54911-5794

Hospital & facility affiliations

  • Thedacare Medical Center-Waupaca Hospital, Waupaca, WI, CCN 521334
  • Thedacare Medical Center - Shawano Hospital, Shawano, WI, CCN 521346
  • Thedacare Medical Center - New London Hospital, New London, WI, CCN 521326
  • Thedacare Regional Med Ctr - Neenah Hospital, Neenah, WI, CCN 520045

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
I20060915000314 WI Practitioner - Physician Assistant 8527063049 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2038WIMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Thedacare, Incorporated Current Accepting new patients
Thedacare Medical Center - New London, Inc CurrentSince Nov 13, 2012 Accepting new patients
Thedacare Medical Center - Berlin, Inc. Past Accepting new patients

Locations

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

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

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

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

100 Cty Road B
Shawano, WI 54166
Phone (715) 524-2161

710 Riverside Dr
Waupaca, WI 54981
Phone (715) 256-3000

Interoperability endpoints

  • Direct secure messaging: tkaepernick48484@direct.thedacare.org

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2038 WI Primary

Addresses

NPPES NPI Registry

Primary practice location

1405 Mill St
New London, WI 54961-2155

Mailing address

1405 Mill St
PO Box 65
New London, WI 54961-2155
Phone (920) 531-2291

Other identifiers 2

NPPES NPI Registry
IdentifierTypeStateIssuer
42890800MedicaidWI
P00391342OtherWIRAILROAD

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 30, 2012.

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343606400000",
    "number": "1922014406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1405 MILL ST",
            "address_2": "PO BOX 65",
            "city": "NEW LONDON",
            "state": "WI",
            "postal_code": "549612155",
            "telephone_number": "920-531-2291",
            "fax_number": "920-531-2207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1405 MILL ST",
            "city": "NEW LONDON",
            "state": "WI",
            "postal_code": "549612155",
            "telephone_number": "920-531-2291",
            "fax_number": "920-531-2207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAEPERNICK",
        "first_name": "TEASHA",
        "middle_name": "L",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-01",
        "last_updated": "2012-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "2038",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42890800",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "P00391342",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New London, WI

Sources for this page

Verify at the official NPI Registry.