DR. SHANICE S KUKUCK APNP
NPI 1063151330
Nurse Practitioner - Pediatrics in West Bend, WI

Q: What is Shanice Kukuck's NPI number?

The NPI number for Shanice Kukuck is 1063151330. It was assigned to this individual provider in the NPPES registry on June 3, 2022.

Q: What is Shanice Kukuck's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Pediatrics, with taxonomy code 363LP0200X.

Q: When was this NPI record last updated?

The NPPES record for Shanice Kukuck was last updated on June 10, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since June 03, 2022PECOS Enrolled

1700 PARADISE DR, WEST BEND, WI 53095(262) 334-3451 Get Directions Write a Review

NPPES record last updated: June 10, 2025. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Jun 10, 2025, Jul 6, 2022, Jun 7, 2022 (3 updates tracked since 2022).

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About Dr. Shanice S Kukuck Apnp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. SHANICE S KUKUCK APNP (NPI 1063151330) is an individual pediatrics provider in West Bend, Wisconsin, licensed in Illinois (209032039) and active in the NPI registry since June 2022. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1063151330

Entity TypeIndividualFemale

Primary Taxonomy363LP0200X

Provider Legal NameDR. SHANICE S KUKUCKCredential: APNP

Location Address1700 PARADISE DRWest Bend, WI 53095-9795

Mailing Address1700 W Paradise DrWest Bend, WI 53095-9795 · (262) 334-3451

Phone(262) 334-3451

Sole ProprietorNo

Enumeration DateJune 3, 2022

Last NPPES UpdateJune 10, 20253 updates tracked since enumeration

NPPES CertifiedJune 10, 2025

✔ NPI 1063151330 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · PediatricsPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LP0200X

License✔ Licensed in IL · 209032039

Also ListedNurse Practitioner · FamilyTaxonomy 363LF0000X · License 209032039 (IL), 11997-33 (WI)

1700 PARADISE DR, West Bend, WI 53095

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Shanice S Kukuck Apnp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

Medicare enrollment records show Shanice Kukuck reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Froedtert & the Medical College Of Wisconsin Community Physicians, Inc.

16 mi

Internal Medicine

W180N8000 TOWN HALL RD
Menomonee Falls, WI 53051

Reassigned Medicare billing, Wisconsin enrollment
2,294 clinicians in this Medicare group

NPI 1568787448 (262) 255-2500

Osf Multi-Specialty Group

196 mi

Internal Medicine

8600 N STATE ROUTE 91
Peoria, IL 61615

Reassigned Medicare billing, Illinois enrollment
2,944 clinicians in this Medicare group

NPI 1154908929 (309) 683-5050

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 3

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

79 services73 patients

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

56 services49 patients

Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439

An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.

11 services11 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 53095 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$82.92 typical visit price

range $53.90 – $163.24

Typical copayment $20.73 (range $13.47 – $40.81)

Most-billed visit code 99203

Established Patient

$95.41 typical visit price

range $17.40 – $133.76

Typical copayment $23.85 (range $4.35 – $33.44)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 10

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ALISSA ASHLEY RUE NP

Nurse Practitioner