Ty Rebedew

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

3306-12 Issued in WI

Practice address

147 N State St
Berlin, WI 54923-1621

Phone

(920) 361-3515

Fax

(920) 361-2733

NPI assigned

Dec 23, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Specialty

Chiropractic

Education

Logan College of Chiropractic, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jaskowiak Chiropractic Office SCGroup PAC ID 5496841058, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Jaskowiak Chiropractic Office SC

  • Chiropractor
  • Menomonee Falls, WI
  • NPI 1720111578
  Medicare reassignment Care Compare group NPD
• Lyons Health, LLC

  • Chiropractor
  • Green Bay, WI
  • NPI 1740439108
  Medicare reassignment NPD
• Wepner Chiropractic Office, S.C.

  • Sports Physician Chiropractor
  • Berlin, WI
  • NPI 1407915937
  NPD
• Back & Body Therapeutic Touch, LLC

  • Specialist
  • Berlin, WI
  • NPI 1831289107
  NPD (past)

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

{
    "created_epoch": "1608681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679529600000",
    "number": "1073100178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "147 N STATE ST",
            "city": "BERLIN",
            "state": "WI",
            "postal_code": "549231621",
            "telephone_number": "920-361-3515",
            "fax_number": "920-361-2733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "147 N STATE ST",
            "city": "BERLIN",
            "state": "WI",
            "postal_code": "549231621",
            "telephone_number": "920-361-3515",
            "fax_number": "920-361-2733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REBEDEW",
        "first_name": "TY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-12-23",
        "last_updated": "2023-03-23",
        "certification_date": "2023-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "3306-12",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5588-12",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael A Puglisi, PA-C
• Mary Ellen F Pumper, RPH
• Anthony J. Racki, MD
• Emily Anne Rademacher, COTA
• Vicki Christine Ray, DNP APNP
• Sherry Lynn Reinsbach, OTA
• Brian Resop
• Daniel J Resop, M.D.
• Ripon Medical Center
• Ripon Medical Center

• Chiropractor in Berlin, WI
• Providers in Berlin, WI by specialty
• Chiropractor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2023; 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.