Individual provider Active NPI

Joseph Kucksdorf, PT

  • Physical Therapist
  • Green Bay, WI
National Provider Identifier
1093035859
Registry record updated Jun 3, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
11460-24 Issued in WI
Practice address
3263 Eaton Rd
Green Bay, WI 54311-6830
Phone
(920) 433-6700
Fax
(920) 430-4745
NPI assigned
Jun 3, 2010
Last updated
Jun 3, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2010

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 11460-24 WI Primary

Addresses

Primary practice location

3263 Eaton Rd
Green Bay, WI 54311-6830

Mailing address

3263 Eaton Rd
Green Bay, WI 54311-6830
Phone (920) 433-6700

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160601002150 WI Practitioner - Physical Therapist in Private Practice 3779873856 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bellin Memorial Hospital IncGroup PAC ID 8820900749, 685 clinicians

Practice addresses (Care Compare)

3415 Custer St D
Manitowoc, WI 54220-4356
Phone (920) 652-9310

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11460-24WIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Bellin Memorial Hospital Inc Physical Therapist CurrentSince May 2, 2018 Accepting new patients
Bellin Memorial Hospital Inc CurrentSince May 2, 2018 Accepting new patients
Bellin Memorial Hospital Inc Current Accepting new patients
Bellin Memorial Hospital Inc Past Accepting new patients

Locations

2305 San Luis Pl
Green Bay, WI 54304
Phone (920) 494-2817

3263 Eaton Rd
Green Bay, WI 54311
Phone (920) 433-6000

744 S Webster Ave
Green Bay, WI 54301
Phone (920) 433-6025

1765 N 18th St
Manitowoc, WI 54220
Phone (920) 482-0575

3415 Custer St
Ste D
Manitowoc, WI 54220
Phone (920) 652-9310

Interoperability endpoints

  • Direct secure messaging: jkucksdorf32303@direct.thedacare.org

Organizations & group practices 4

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": "1275523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1275523200000",
    "number": "1093035859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3263 EATON RD",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543116830",
            "telephone_number": "920-433-6700",
            "fax_number": "920-430-4745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3263 EATON RD",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543116830",
            "telephone_number": "920-433-6700",
            "fax_number": "920-430-4745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUCKSDORF",
        "first_name": "JOSEPH",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-03",
        "last_updated": "2010-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "11460-24",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2010; 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.