Individual provider Active NPI

Nikolai S Miskov, DPT

  • Physical Therapist
  • Salem, WI
National Provider Identifier
1063863264
Registry record updated Oct 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
13558-24 Issued in WI
Practice address
25250 75TH St
Salem, WI 53168-8705
Phone
(262) 843-4200
Fax
(262) 843-4578
NPI assigned
Jun 29, 2016
Last updated
Oct 8, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2024

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 13558-24 WI Primary

Addresses

Primary practice location

25250 75TH St
Salem, WI 53168-8705

Mailing address

625 Enterprise Dr
Oak Brook, IL 60523-8813
Phone (630) 590-4029

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161031000061 WI Practitioner - Physical Therapist in Private Practice 4789962580 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Athletico LTDGroup PAC ID 4789602681, 2,187 clinicians

Practice addresses (Care Compare)

15175 W National Ave
New Berlin, WI 53151-5150
Phone (262) 649-2135

2615 N Downer Ave
Milwaukee, WI 53211-4245
Phone (414) 962-4400

3077 N Mayfair Rd
Suite 105
Wauwatosa, WI 53222-4305
Phone (414) 455-5797

5708 B 75TH St
Kenosha, WI 53142-3635
Phone (262) 697-9135

Merit-based Incentive Payment System (MIPS)

Final score
86.32 of 100Reported as group
Quality
84.44
Promoting interoperability
99
Improvement activities
40
Cost
70.78

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Athletico LTD Physical Therapist CurrentSince Dec 1, 2018 Accepting new patients
Athletico LTD Physical Therapist CurrentSince Dec 1, 2018 Accepting new patients
Athletico LTD Physical Therapist Current Accepting new patients

Locations

625 Enterprise Dr
Oak Brook, IL 60523
Phone (630) 575-6250

3701 80th St
Kenosha, WI 53142
Phone (262) 697-1730

5708 75th St
#B
Kenosha, WI 53142
Phone (262) 697-9135

2615 N Downer Ave
Milwaukee, WI 53211
Phone (414) 962-4400

15175 W National Ave
New Berlin, WI 53151
Phone (262) 649-2135

25250 75th St
Salem, WI 53168
Phone (262) 843-4200

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": "1467158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728345600000",
    "number": "1063863264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 ENTERPRISE DR",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605238813",
            "telephone_number": "630-590-4029",
            "fax_number": "630-590-4329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25250 75TH ST",
            "city": "SALEM",
            "state": "WI",
            "postal_code": "531688705",
            "telephone_number": "262-843-4200",
            "fax_number": "262-843-4578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MISKOV",
        "first_name": "NIKOLAI",
        "middle_name": "S",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-29",
        "last_updated": "2024-10-08",
        "certification_date": "2024-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "13558-24",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2024; 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.