Individual provider Active NPI

Elizabeth Mary Roe, PT

  • Physical Therapist
  • Sun Prairie, WI
National Provider Identifier
1003094558
Registry record updated Nov 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
10030-024 Issued in WI
Practice address
10 Tower Dr
Sun Prairie, WI 53590-1239
Phone
(608) 825-3500
Fax
(608) 825-3598
NPI assigned
Feb 7, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 10030-024 WI Primary

Addresses

Primary practice location

10 Tower Dr
Sun Prairie, WI 53590-1239

Mailing address

10 Tower Dr
Sun Prairie, WI 53590-1239
Phone (608) 825-3500

Other identifiers 1

IdentifierTypeStateIssuer
1578570974MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address eroe260368@direct-ehr-ssmhc.com Direct
FHIR URL https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ Other

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211214001295 WI Practitioner - Physical Therapist in Private Practice 2668862210 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dean Health Systems IncGroup PAC ID 7012827983, 1,174 clinicians

Practice addresses (Care Compare)

10 Tower Dr
Sun Prairie, WI 53590-1239
Phone (608) 825-3500

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10030-024WIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Dean Health Systems, Inc CurrentSince Jan 3, 2022 Accepting new patients
Dean Health Systems, Inc. CurrentSince Jan 3, 2022 Accepting new patients

Locations

752 N High Point Rd
Madison, WI 53717
Phone (608) 824-4000

1808 W Beltline Hwy
Madison, WI 53713
Phone (608) 250-1497

515 22nd Ave
Monroe, WI 53566
Phone (608) 324-1000

10 Tower Dr
Sun Prairie, WI 53590
Phone (608) 825-3008

Interoperability endpoints

  • Direct secure messaging: eroe260368@direct-ehr-ssmhc.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1202342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606089600000",
    "number": "1003094558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 TOWER DR",
            "city": "SUN PRAIRIE",
            "state": "WI",
            "postal_code": "535901239",
            "telephone_number": "608-825-3500",
            "fax_number": "608-825-3598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 TOWER DR",
            "city": "SUN PRAIRIE",
            "state": "WI",
            "postal_code": "535901239",
            "telephone_number": "608-825-3500",
            "fax_number": "608-825-3598"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROE",
        "first_name": "ELIZABETH",
        "middle_name": "MARY",
        "name_prefix": "Mrs.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-07",
        "last_updated": "2020-11-23",
        "certification_date": "2020-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "10030-024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1578570974",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "eroe260368@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "eroe260368@direct-ehr-ssmhc.com",
            "address_1": "10 Tower Dr",
            "city": "Sun Prairie",
            "state": "WI",
            "country_code": "US",
            "postal_code": "535901239",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "10 Tower Dr",
            "city": "Sun Prairie",
            "state": "WI",
            "country_code": "US",
            "postal_code": "535901239",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Sun Prairie, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.