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MACKENZIE RAE KETTERHAGEN PA-C
NPI 1821979519
Physician Assistant - Surgical in Chesterton, IN

Active since September 09, 2025PECOS EnrolledAccepts Medicare Assignment
601 GATEWAY BLVD N, CHESTERTON, IN 46304(219) 921-1444(219) 921-5303 Get Directions Write a Review

NPPES record last updated: September 9, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Mackenzie Rae Ketterhagen Pa-c NPPES

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

MACKENZIE RAE KETTERHAGEN PA-C (NPI 1821979519) is an individual surgical provider in Chesterton, Indiana and active in the NPI registry since September 2025. She is enrolled in Medicare PECOS, maintains 3 additional practice locations, and is a graduate of Other (2025).

NPPES Registry Identity

NPI1821979519
Entity TypeIndividualFemale
Primary Taxonomy363AS0400X
Provider Legal NameMACKENZIE RAE KETTERHAGENCredential: PA-C
Location Address601 GATEWAY BLVD NChesterton, IN 46304-9658
Mailing Address601 Gateway Blvd NChesterton, IN 46304-9658 · (219) 921-1444 · Fax (219) 921-5303
Phone(219) 921-1444
Fax(219) 921-5303
Sole ProprietorNo
Medical School CMSOtherGraduated 2025
Enumeration DateSeptember 9, 2025
NPPES CertifiedSeptember 9, 2025
✔ NPI 1821979519 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPhysician Assistant · SurgicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AS0400X
Also ListedPhysician AssistantTaxonomy 363A00000X

Secondary Practice Locations 3

Location 1500 E 109th AveCrown Point, IN 46307-7294 · Phone (219) 921-1444 · Fax (219) 921-5303
Location 23691 Willowcreek RdPortage, IN 46368-5080 · Phone (219) 921-1444 · Fax (219) 921-5303
Location 3833 W Lincoln Hwy Ste 110ESchererville, IN 46375-4606 · Phone (219) 921-1444 · Fax (219) 921-5303

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

Mackenzie Rae Ketterhagen Pa-c 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 ID1658863915
PECOS Enrollment IDI20251124002967
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.

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.

ANITA K. RAO M.D.
Pain Medicine (Interventional Pain Medicine)
601 GATEWAY BLVD N
CHESTERTON, IN 46304
Porter County (219) 921-1444
BRIAN THOMAS DAMITZ D.P.M.
Podiatrist
601 GATEWAY BLVD N
CHESTERTON, IN 46304
Porter County (219) 921-1444
SAMANTHA HIGGINS DPT
Physical Therapist
601 GATEWAY BLVD N
CHESTERTON, IN 46304
Porter County (219) 921-1444
GAGE ALAN THOMA PA-C
Physician Assistant (Surgical)
601 GATEWAY BLVD N
CHESTERTON, IN 46304
Porter County (219) 921-1444
APRIL MARIE PRZYBORSKI PA-C
Physician Assistant
601 GATEWAY BLVD N
CHESTERTON, IN 46304
Porter County (219) 921-1444
ERIC KRISTIAN SZCZESNIAK M.D.
Orthopaedic Surgery
601 GATEWAY BLVD N, APT. 409
CHESTERTON, IN 46304
Porter County (219) 921-1444
THOMAS H KAY M.D.
Orthopaedic Surgery
601 GATEWAY BLVD N
CHESTERTON, IN 46304
Porter County (219) 921-1444
NATALIE JOAN EDDY NP
Nurse Practitioner
601 GATEWAY BLVD N, #A
CHESTERTON, IN 46304
Porter County (219) 921-1444

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 Mackenzie Ketterhagen's NPI number?

The NPI number for Mackenzie Ketterhagen is 1821979519. It was assigned to this individual provider in the NPPES registry on September 9, 2025.

Where is Mackenzie Ketterhagen located?

Mackenzie Ketterhagen practices at 601 Gateway Blvd N, Chesterton, IN 46304. The listed phone number is (219) 921-1444.

What is Mackenzie Ketterhagen's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Surgical, with taxonomy code 363AS0400X.

Is Mackenzie Ketterhagen enrolled in Medicare?

Yes. Mackenzie Ketterhagen 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.

When was this NPI record last updated?

The NPPES record for Mackenzie Ketterhagen was last updated on September 9, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.