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
Last updated
Jul 30, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2012

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 2038 WI Primary

Addresses

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

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

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

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 - New London, Inc CurrentSince Nov 13, 2012 Accepting new patients
Thedacare Medical Center - Shawano, Inc. Past Accepting new patients

Locations

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

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

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

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": "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": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New London, WI

Sources for this page

Verify at the official NPI Registry.