KELLY LEE DITTBERNER (NPI# 1376710251) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376710251 |
| Entity Type | Individual |
| Full Name | KELLY LEE DITTBERNER |
| Practice Address |
215 Northridge Dr Portage WI 53901-9294 |
| Mailing Address |
W12250 Hillcrest Dr Lodi WI 53555-9329 |
| Practice Telephone | 6085169337 |
| Practice Fax Number | 6087450333 |
| Mailing Telephone | 6085169337 |
| Mailing Fax Number | 6085925818 |
| Enumeration Date | 2008-05-10 |
| Last Update Date | 2008-05-10 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251E00000X | Home Health | Agencies |
| Street Address |
215 NORTHRIDGE DR |
| City | PORTAGE |
| State | WI |
| Zip Code | 53901-9294 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396909610 | Rest Assured Home Health Care LLC | Home Health | 215 Northridge Dr, Portage, WI 53901-9294 | 2008-07-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740710748 | Robert James Corliss | Internal Medicine | St. Vincent Fmc, 140east Cook St., Portage, WI 53901 | 2017-06-13 |
| 1639328867 | Casey Jo Ambort | Speech-Language Pathologist | 626 East Slifer St, Portage, WI 53901 | 2008-09-11 |
| 1871767400 | Planned Parenthood of Wi, Inc | Non-Pharmacy Dispensing Site | 132 W. Cook St., Portage, WI 53901 | 2008-04-15 |
| 1881872158 | Marta Jean Jindra | Physical Therapist | 626 E Slifer Street, Portage, WI 53901 | 2008-02-08 |
| 1699953976 | Lana Marie Edwards | Speech-Language Pathologist | 626 East Slifer Street, Portage, WI 53901 | 2008-02-08 |
| 1134314552 | Kristina Hellenbrand | Physical Therapist | 2639 New Pinery Road, Suite 2, Portage, WI 53901 | 2007-09-10 |
| 1689727810 | Gregory Allan Bindl | Chiropractor | 2121new Pinery Rd, Portage, WI 53901 | 2007-01-19 |
| 1720149156 | Timothy J Rosin Dds Sc | Dentist | 2570 New Pinery Rd, Portage, WI 53901 | 2006-12-12 |
| 1710083779 | Currani Seubert Dental Office LLC | Dentist | 260 W Cook St, Portage, WI 53901 | 2006-09-16 |
| 1225090525 | University of Wisconsin Medical Foundation Inc | Durable Medical Equipment & Medical Supplies | 2977 Cty Hwy Cx, Portage, WI 53901 | 2006-04-04 |
| Find all providers in zip 53901 | ||||
| Taxonomy Code | 251E00000X |
| Grouping | Agencies |
| Classification | Home Health |
| A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety. |
| Notes: Source: CFR42 Chapter IV Part 484, http://www.access.gpo.gov/nara/cfr/waisidx_99/42cfr484_99.html [7/1/2007: definition added, source added] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184002479 | E Medical Group of Michigan No. 2, LLC | Home Health | 7127 S Westnedge Ave, Suite 5-d, Portage, MI 49002-4276 | 2015-05-07 |
| 1386045383 | Pinnacle Senior Care of Kalamazoo, LLC | Home Health | 2725 Airview Blvd Ste 105b, Portage, MI 49002 | 2014-09-09 |
| 1326347626 | Arc Therapy Services LLC | Home Health | 3444 Swanson Rd, Portage, IN 46368-4999 | 2011-03-25 |
| 1447562103 | Lakeshore Home Care, Inc. | Home Health | 614 Romence Rd, Suite 250, Portage, MI 49024-3613 | 2010-07-10 |
| 1245464668 | Arbor Woods Home Health Care, Inc. | Home Health | 1615 W Centre Ave Ste 201, Portage, MI 49024 | 2009-05-13 |
| 1427223684 | Amedisys Indiana, L.l.c | Home Health | 3363 Willowcreek Rd, Portage, IN 46368-5015 | 2008-04-28 |
| 1811017965 | Home Health Crusaders, Inc. | Home Health | 3191 Willowcreek Rd, Portage, IN 46368-4446 | 2007-03-30 |
| 1942340377 | Absolute Homecare and Medical Staffing | Home Health | 8080 Moors Bridge Rd, Suite 202, Portage, MI 49024-4421 | 2007-02-07 |
| 1093801219 | Paragon Home Healthcare, Inc. | Home Health | 601 E Centre Ave, Portage, MI 49002-5514 | 2006-10-05 |
| 1528084985 | Prac Holdings, Inc. | Home Health | 669 Romence Rd, Portage, MI 49024-3446 | 2006-07-15 |
| Find all providers in PORTAGE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.