Active NPI
Maddison Banach
- Physical Therapist
- Fort Atkinson, WI
National Provider Identifier
1033035704
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 17853-24
- Practice address
- 740 Reena Ave
Fort Atkinson, WI 53538-3145 - Phone
- (920) 563-0888
- NPI assigned
- Jun 26, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 17853-24 | WI | Primary |
Addresses
Primary practice location
740 Reena Ave
Fort Atkinson, WI 53538-3145
Mailing address
438 W Red Pine Cir
Dousman, WI 53118-8823
Phone (262) 431-4744
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| FHIR URL | https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ | Other | |
| Direct Messaging Address | mbanach518165@direc-ehr-ssmhc.com | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1782432000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1788393600000",
"number": "1033035704",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "438 W RED PINE CIR",
"city": "DOUSMAN",
"state": "WI",
"postal_code": "531188823",
"telephone_number": "262-431-4744"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "740 REENA AVE",
"city": "FORT ATKINSON",
"state": "WI",
"postal_code": "535383145",
"telephone_number": "920-563-0888"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BANACH",
"first_name": "MADDISON",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-06-26",
"last_updated": "2026-09-03",
"certification_date": "2026-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "17853-24",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"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": "740 Reena Ave",
"city": "Fort Atkinson",
"state": "WI",
"country_code": "US",
"postal_code": "535383145",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "mbanach518165@direc-ehr-ssmhc.com",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "mbanach518165@direc-ehr-ssmhc.com",
"address_1": "740 Reena Ave",
"city": "Fort Atkinson",
"state": "WI",
"country_code": "US",
"postal_code": "535383145",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Fort Atkinson, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.