Individual provider Active NPI

Andrew James Hajduk, P.T.

  • Physical Therapist
  • Mount Pleasant, WI
National Provider Identifier
1063640134
Registry record updated Apr 19, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
11862-24 Issued in WI
Practice address
5502 Washington Ave
Suite 500
Mount Pleasant, WI 53406-4093
Phone
(262) 637-2470
NPI assigned
Jun 29, 2009
Last updated
Apr 19, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 070-017222 IL
Physical Therapist 225100000X 11862-24 WI Primary

Addresses

Primary practice location

5502 Washington Ave
Suite 500
Mount Pleasant, WI 53406-4093

Mailing address

790 Remington Blvd
Bolingbrook, IL 60440-4909
Phone (630) 296-2223

Other identifiers 1

IdentifierTypeStateIssuer
P00750703OtherILMEDICARE RAILROAD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110919000772 WI Practitioner - Physical Therapist in Private Practice 9638223522 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
83.05 of 100Reported as group
Quality
88.38
Improvement activities
40
Cost
64.82

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
070-017222ILMDPhysical Therapist
11862-24WIMDPhysical Therapist
11862WIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Athletic & Therapeutic Institute of Milwaukee, LLC Physical Therapist Current Accepting new patients
Athletic & Therapeutic Institute of Milwaukee, LLC Physical Therapist CurrentSince Apr 19, 2017 Accepting new patients
Athletic & Therapeutic Institute of Milwaukee, LLC Physical Therapist CurrentSince Apr 19, 2017 Accepting new patients

Locations

790 Remington Blvd
Bolingbrook, IL 60440

5502 Washington Ave
Ste 500
Mount Pleasant, WI 53406
Phone (262) 637-2470

S74W16867 Janesville Rd
Muskego, WI 53150
Phone (262) 971-4200

6810 W State St
Wauwatosa, WI 53213
Phone (414) 259-0623

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1246233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1492560000000",
    "number": "1063640134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909",
            "telephone_number": "630-296-2223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5502 WASHINGTON AVE",
            "address_2": "SUITE 500",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "534064093",
            "telephone_number": "262-637-2470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAJDUK",
        "first_name": "ANDREW",
        "middle_name": "JAMES",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-29",
        "last_updated": "2017-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070-017222",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "11862-24",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00750703",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Pleasant, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2017; 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.