MACKENZIE RAE KETTERHAGEN (PA-C) – Surgical Physician Assistant, NPI 1821979519
Surgical Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
2,510 PHYSICIAN ASSISTANT in IN
Provider Addresses for MACKENZIE RAE KETTERHAGEN (PA-C)
833 W Lincoln Hwy Ste 110E
Schererville, IN 463754606
Phone: (219) 921-1444
Fax: (219) 921-5303
Type: Location
500 E 109th Ave
Crown Point, IN 463077294
Phone: (219) 921-1444
Fax: (219) 921-5303
Type: Location
3691 Willowcreek Rd
Portage, IN 463685080
Phone: (219) 921-1444
Fax: (219) 921-5303
Type: Location
601 GATEWAY BLVD N
CHESTERTON, IN 463049658
Phone: (219) 921-1444
Fax: (219) 921-5303
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2025-11-24
PECOS data refreshed: 2026-06-15
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20251124002967 | I | Physician Assistant | IN | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 46375)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Physical Therapist In Private Practice | IL | |
| Physician Assistant | IN | |
| Occupational Therapist In Private Practice | IL | |
| Orthopedic Surgery | IN | |
| Physical Therapist In Private Practice | IL | |
| Physical Therapist In Private Practice | IN | |
| Physical Therapist In Private Practice | IN | |
| - | IN | |
| Physician Assistant | IN | |
| Physical Therapist In Private Practice | IN |
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