Individual provider Active NPI

Tessa Traynor, DPT

  • Physical Therapist
  • Turtle Lake, WI
National Provider Identifier
1083307235
Registry record updated Jun 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
16321-24 Issued in WI
Practice address
100 Becker St
Turtle Lake, WI 54889-9205
Phone
(715) 986-4103
Fax
(715) 986-4128
NPI assigned
Jun 1, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2023

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 16321-24 WI Primary

Addresses

Primary practice location

100 Becker St
Turtle Lake, WI 54889-9205

Mailing address

P.O. Box 147
Clear Lake, WI 54005-8905
Phone (715) 263-4103

Other practice location 1

224 River Ave S
Prairie Farm, WI 54762-9786
Phone (715) 455-4103

Other practice location 2

930 Elden Ave
Amery, WI 54001-1448
Phone (715) 268-5103

Other practice location 3

417 3rd Avenue
Clear Lake, WI 54005-8905
Phone (715) 263-4103

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230616001824 WI Practitioner - Physical Therapist in Private Practice 7719345149 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Clear Lake Physical Therapy and Rehab Specialists LLCGroup PAC ID 0749327526, 4 clinicians

Practice addresses (Care Compare)

100 Becker St
Turtle Lake, WI 54889-9205
Phone (715) 986-4103

Merit-based Incentive Payment System (MIPS)

Final score
83.07 of 100Reported as group
Quality
99.91
Improvement activities
40
Cost
43.69

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
16321-24WIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Clear Lake Physical Therapy and Rehab Specialists LLC Physical Therapist CurrentSince Jun 1, 2023 Accepting new patients
Clear Lake Physical Therapy and Rehab Specialists LLC CurrentSince Jun 1, 2023 Accepting new patients

Locations

930 Elden Ave
Amery, WI 54001
Phone (715) 268-5103

100 Becker St
Turtle Lake, WI 54889
Phone (715) 263-4103

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": "1685577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685577600000",
    "number": "1083307235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 147",
            "city": "CLEAR LAKE",
            "state": "WI",
            "postal_code": "540058905",
            "telephone_number": "715-263-4103",
            "fax_number": "715-263-4110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 BECKER ST",
            "city": "TURTLE LAKE",
            "state": "WI",
            "postal_code": "548899205",
            "telephone_number": "715-986-4103",
            "fax_number": "715-986-4128"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "224 River Ave S",
            "address_purpose": "LOCATION",
            "city": "Prairie Farm",
            "state": "WI",
            "postal_code": "547629786",
            "country_code": "US",
            "telephone_number": "715-455-4103",
            "fax_number": "715-455-4106",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "930 Elden Ave",
            "address_purpose": "LOCATION",
            "city": "Amery",
            "state": "WI",
            "postal_code": "540011448",
            "country_code": "US",
            "telephone_number": "715-268-5103",
            "fax_number": "715-268-5101",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "417 3rd Avenue",
            "address_purpose": "LOCATION",
            "city": "Clear Lake",
            "state": "WI",
            "postal_code": "540058905",
            "country_code": "US",
            "telephone_number": "715-263-4103",
            "fax_number": "715-263-4110",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TRAYNOR",
        "first_name": "TESSA",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-01",
        "last_updated": "2023-06-01",
        "certification_date": "2023-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "16321-24",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Turtle Lake, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 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.