REBECCA L KETTERHAGEN (PA) – Physician Assistant, NPI 1871004655
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
3,678 PHYSICIAN ASSISTANT in WI
Provider Addresses for REBECCA L KETTERHAGEN (PA)
100 County Road B
Shawano, WI 54166
Phone: (715) 524-2161
Fax: (715) 524-8164
Type: Location
122, East College Avenue, Appleton, Outagamie County, Wisconsin, 54911, United States
APPLETON, WI 549115794
Phone: (920) 996-3264
Fax: (920) 830-5970
Type: Mailing
ThedaCare Medical Center-Shawano, 100, County Road B, Shawano, Town of Waukechon, Shawano County, Wisconsin, 54166, United States
SHAWANO, WI 54166
Phone: (715) 524-2161
Fax: (715) 524-8164
Type: Location
1726 SHAWANO AVE
GREEN BAY, WI 543033216
Phone: (920) 429-1700
Fax: (920) 830-5970
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 30 Open Payments records for all available years, with a total value of $640.
Total Amount is formed as General ($640) + Research ($0) + Ownership ($0) = $640.
Last reported payment date: 2024-11-19 • Largest payer in this snapshot: Janssen Biotech, Inc. ($235).
Total Amount
$640
General + Research + Ownership
Payments
30
Total payment records
General Amount
$640
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-11-19
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Janssen Biotech, Inc. | $235 |
| ABBVIE INC. | $130 |
| Boston Scientific Corporation | $113 |
| Enterra Medical, Inc. | $84 |
| Regeneron Healthcare Solutions, Inc. | $63 |
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: 2017-11-28
PECOS data refreshed: 2026-05-27
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 |
|---|---|---|---|---|
| I20171128001547 | I | Physician Assistant | WI | 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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 64 | 51 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 48 | 45 | $0 |
| 36415 | Insertion of needle into vein for collection of blood sample | 38 | 28 | $0 |
| 85025 | Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count | 21 | 16 | $0 |
| 91200 | Measurement of liver stiffness | 19 | 18 | $0 |
Insurance plans in this area (ZIP 54166)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| P O D I A T R Y | WI | |
| - | WI | |
| - | WI | |
| Family Practice, Sports Medicine | WI | |
| - | OH | |
| Physical Therapist In Private Practice | WI | |
| - | WI | |
| - | WI | |
| Internal Medicine, Hospitalist | WI | |
| - | WI |
Reviews
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