GREGORY KETTELHAKE AU.D.
NPI 1366824690
Audiologist in Auburn, CA
About Gregory Kettelhake Au.d. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
GREGORY KETTELHAKE AU.D. (NPI 1366824690) is an individual audiologist in Auburn, California, licensed in California (3058) and active in the NPI registry since June 2015.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Gregory Kettelhake Au.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Gregory Kettelhake reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Stockton, CA 95210
- Reassigned Medicare billing, California enrollment
- 20,078 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Other Providers at the Same Location NPPES 2
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Gregory Kettelhake's NPI number?
The NPI number for Gregory Kettelhake is 1366824690. It was assigned to this individual provider in the NPPES registry on June 23, 2015.
Where is Gregory Kettelhake located?
Gregory Kettelhake practices at 11990 Heritage Oak Pl Ste 11, Auburn, CA 95603. The listed phone number is (530) 823-7532.
What is Gregory Kettelhake's specialty?
The primary specialty registered for this NPI is Audiologist with taxonomy code 231H00000X.
Is Gregory Kettelhake enrolled in Medicare?
Yes. Gregory Kettelhake is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Gregory Kettelhake's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Gregory Kettelhake reassigns Medicare benefits to Permanente Medical Group Inc (Stockton, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Gregory Kettelhake's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Gregory Kettelhake was last updated on January 3, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years 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.
# Gregory Kettelhake, AU.D. · NPI 1366824690
Audiologist provider in Auburn, California. Individual provider, active in the CMS NPPES registry since June 23, 2015.
## Identity
- **NPI:** 1366824690 (Entity type: Individual)
- **Enumerated:** June 23, 2015
- **Primary specialty:** Audiologist · taxonomy 231H00000X
- **State license:** 3058 (California)
- **Sole proprietor:** No
## Practice location
- **Address:** 11990 HERITAGE OAK PL STE 11, Auburn, CA 95603-2405
- **Phone:** (530) 823-7532
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Bills Medicare through:** Permanente Medical Group Inc (NPI 1548343510, Stockton, CA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** January 3, 2022
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Source: [NPI Profile](https://npiprofile.com/npi/1366824690) · Data from the CMS NPPES public registry.