MR. KELLY JONATHON DOUCK CRNA
NPI 1447807086
Nurse Anesthetist, Certified Registered in Wausau, WI
About Mr. Kelly Jonathon Douck Crna NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MR. KELLY JONATHON DOUCK CRNA (NPI 1447807086) is an individual nurse anesthetist, certified registered in Wausau, Wisconsin, licensed in Wisconsin (127347) and active in the NPI registry since August 2019. He is enrolled in Medicare PECOS, is affiliated with Langlade Hospital, and is a graduate of Other (2019).
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 and accepts Medicare assignment
Mr. Kelly Jonathon Douck Crna is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignments
2Medicare enrollment records show Kelly Douck reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Wausau, WI 54401
- Reassigned Medicare billing, Wisconsin enrollment
- 37 clinicians in this Medicare group
Wausau, WI 54401
- Reassigned Medicare billing, Wisconsin enrollment
- Medicare enrollment name: Langlade Hospital - Hotel Dieu Of St Joseph Of Antigo Wisconsin
- Also billed through NPI 1821151366 (Wisconsin)
- 321 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.
Hospital Affiliations CMS Care Compare
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
Langlade Hospital
Critical Access Hospitals · Antigo, WIPhysician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 54401 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Medicare Quality Performance CMS QPP · MIPS
Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
WAUSAU, WI 54401
WAUSAU, WI 54401
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 Kelly Douck's NPI number?
The NPI number for Kelly Douck is 1447807086. It was assigned to this individual provider in the NPPES registry on August 19, 2019.
Where is Kelly Douck located?
Kelly Douck practices at 333 Pine Ridge Blvd, Wausau, WI 54401. The listed phone number is (715) 845-5505.
What is Kelly Douck's specialty?
The primary specialty registered for this NPI is Nurse Anesthetist, Certified Registered with taxonomy code 367500000X.
Is Kelly Douck enrolled in Medicare?
Yes. Kelly Douck is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organizations bill Medicare for Kelly Douck's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Kelly Douck reassigns Medicare benefits to 2 organizations: Central Wisconsin Anesthesiology (Wausau, WI) and Langlade Memorial Hospital Hotel Dieu Of St Joseph (Wausau, WI). Each 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 Kelly Douck's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
Is Kelly Douck affiliated with any hospitals?
According to CMS data, Kelly Douck is affiliated with Langlade Hospital.
When was this NPI record last updated?
The NPPES record for Kelly Douck was last updated on September 20, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.
# Mr. Kelly Jonathon Douck, CRNA · NPI 1447807086
Nurse Anesthetist, Certified Registered physician in Wausau, Wisconsin. Individual provider, active in the CMS NPPES registry since August 19, 2019.
## Identity
- **NPI:** 1447807086 (Entity type: Individual)
- **Enumerated:** August 19, 2019
- **Primary specialty:** Nurse Anesthetist, Certified Registered · taxonomy 367500000X
- **State license:** 127347 (Wisconsin)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 333 PINE RIDGE BLVD, Wausau, WI 54401-4102
- **Phone:** (715) 845-5505
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): Central Wisconsin Anesthesiology (NPI 1518999648, Wausau, WI); Langlade Memorial Hospital Hotel Dieu Of St Joseph (NPI 1871630863, Wausau, WI) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2019
## Record status
- **NPPES last updated:** September 20, 2019
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Source: [NPI Profile](https://npiprofile.com/npi/1447807086) · Data from the CMS NPPES public registry.