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SOURASACK KIT VONGSA MD
NPI 1619945524
Family Medicine in Appleton, WI

Active since March 08, 2006PECOS EnrolledAccepts Medicare Assignment
2500 E CAPITOL DR STE 1200, APPLETON, WI 54911(920) 830-6877(800) 236-2236 Get Directions Write a Review

NPPES record last updated: August 19, 2019. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Aug 19, 2019, Nov 1, 2017 (2 updates tracked since 2017).

About Sourasack Kit Vongsa Md NPPES

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

SOURASACK KIT VONGSA MD (NPI 1619945524) is an individual family medicine provider in Appleton, Wisconsin, licensed in Wisconsin (47253) and active in the NPI registry since March 2006. He is enrolled in Medicare PECOS, is affiliated with Thedacare Regional Med Ctr - Neenah, and maintains a secondary practice location in Appleton.

NPPES Registry Identity

NPI1619945524
Entity TypeIndividualMale
Primary Taxonomy207Q00000X
Provider Legal NameSOURASACK KIT VONGSACredential: MD
Location Address2500 E CAPITOL DR STE 1200Appleton, WI 54911
Mailing Address122 E College AveAppleton, WI 54911-5794 · (920) 996-3264 · Fax (920) 830-5970
Phone(920) 830-6877
Fax(800) 236-2236
Sole ProprietorNo
Medical School CMSOtherGraduated 2003
Enumeration DateMarch 8, 2006
Last NPPES UpdateAugust 19, 20192 updates tracked since enumeration
✔ NPI 1619945524 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in WI · 47253
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
2500 E CAPITOL DR STE 1200, Appleton, WI 54911
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Secondary Practice Location 1

Location 13329 N Richmond StAppleton, WI 54911 · Phone (920) 380-2727 · Fax (920) 380-2726

Other Identifiers 1

Medicaid34808400WI

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Aspirus Health Plan, CareSource (Common Ground Healthcare).Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Sourasack Kit Vongsa Md 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.

PECOS PAC ID8224051131
PECOS Enrollment IDI20060106000116
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.

Areas of Expertise CMS Part B claims 4

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.
102 services100 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.
33 services33 patients
Manual urinalysis test with examination using microscope, automated 81001
A manual urinalysis test with automated microscopic examination is a lab process that checks your urine for health indicators. It involves a machine scanning your sample to identify any abnormal elements, which can assist in diagnosing various conditions.
25 services25 patients
X-ray of chest, 2 views 71046
A chest X-ray, 2 views, is a quick, painless test that creates pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. Two different angles are used to get a comprehensive view. This helps in diagnosing conditions like pneumonia, heart problems, or lung cancer.
20 services18 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Thedacare Regional Med Ctr - Neenah

Acute Care Hospitals · Neenah, WI
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number520045
Location130 2nd StNeenah, WI 54956 · Winnebago County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 54911 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 2

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

TODD L MCNIESH MPAS, PA-C
Physician Assistant
2500 E CAPITOL DR STE 1200
APPLETON, WI 54911
Outagamie County (920) 830-6877
CHELSEY S MCNABB PENDER MD
Internal Medicine
2500 E CAPITOL DR STE 1200
APPLETON, WI 54911
Outagamie County (920) 731-5811

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 Sourasack Vongsa's NPI number?

The NPI number for Sourasack Vongsa is 1619945524. It was assigned to this individual provider in the NPPES registry on March 8, 2006.

Where is Sourasack Vongsa located?

Sourasack Vongsa practices at 2500 E Capitol Dr Ste 1200, Appleton, WI 54911. The listed phone number is (920) 830-6877.

What is Sourasack Vongsa's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Sourasack Vongsa enrolled in Medicare?

Yes. Sourasack Vongsa 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.

What insurance does Sourasack Vongsa accept?

Health plans from Aspirus Health Plan and CareSource (Common Ground Healthcare) list Sourasack Vongsa as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Sourasack Vongsa affiliated with any hospitals?

According to CMS data, Sourasack Vongsa is affiliated with Thedacare Regional Med Ctr - Neenah.

When was this NPI record last updated?

The NPPES record for Sourasack Vongsa was last updated on August 19, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.