Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1952508400 Individual Practitioner Male Practitioner

Keith J Hacker , PA

Physician Assistant • Port Washington, WI

Professional Overview & Biography Verified Profile Summary

Keith Hacker, PA is a registered healthcare professional specializing in Physician Assistant in Port Washington, WI. Practice services are available at 1777 W GRAND AVE under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

1777 W Grand Ave

Port Washington, WI 530742077

Telephone 2622843456
Associated Practice Facility / Clinic
🏢 Advanced Healthcare, S.c. Facility NPI 1417037581

Specialty Benchmarks & Practice Insights

Comparative analytics for Physician Assistant in Port Washington, WI

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 14.0 Yrs
State Avg: 14.1 Yrs
Regional Practice Density
5 Specialists

Practicing in Port Washington, WI (3517 Statewide)

Telehealth Adoption Rate
20.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2021-11-23
Physician Assistant Primary Specialty

NUCC Taxonomy Code: 363A00000X

State License WI 523

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
1952508400 (WI)

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

7 Associated Practitioners
Dr. Kenneth Jensen , MD

Internal Medicine

NPI 1003841784

Doctor of Medicine (M.D.)

NPI 1003925629

Doctor of Medicine (M.D.)

NPI 1245346543

Doctor of Chiropractic

Dr. Mark Bostwick , MD

Internal Medicine

NPI 1487686614

Doctor of Medicine (M.D.)

Anjuli Tuscano , PA-C

Physician Assistant

NPI 1669855656

Physician Assistant (Certified)

NPI 1871525014

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events
NPI Profile Active October 14, 2016

NPI status registered as active in NPPES database

📍
Updated Practice Location October 14, 2016

Registered at 1777 W GRAND AVE, PORT WASHINGTON, WI 530742077 (Tel: 2622843456)

📍
Updated Business Mailing Address October 14, 2016

Registered at 1777 W GRAND AVE, PORT WASHINGTON, WI 530742077 (Tel: 2622843456)

👤
Provider Name / Credentials Updated October 14, 2016

Recorded as KEITH HACKER, P.A.

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) October 14, 2016

Physician Assistant (License #523 in WI)

🟢
Initial NPI Registration & Enumeration June 28, 2007

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1952508400
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: June 28, 2007
Last Update: November 23, 2021
Sole Proprietor: No

Mailing Address

1777 W Grand Ave

Port Washington, WI 530742077

Phone: 2622843456

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.