Individual provider Active NPI

Borys Kusyk, DPM

  • Podiatrist
  • Baraboo, WI
National Provider Identifier
1104883933
Registry record updated Dec 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
549-025 Issued in WI
Practice address
1626 Tuttle St
Baraboo, WI 53913
Phone
(608) 355-6868
Fax
(608) 355-7001
NPI assigned
Apr 26, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X 549-025 WI Primary

Addresses

Primary practice location

1626 Tuttle St
Baraboo, WI 53913

Mailing address

1626 Tuttle St
Baraboo, WI 53913
Phone (608) 355-6868

Other identifiers 1

IdentifierTypeStateIssuer
1104883933MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address bkusyk261214@direct-ehr-ssmhc.com Direct
FHIR URL https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ Other

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051222000364 WI Practitioner - Podiatry 9436171188 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
549WIMDCritical Care Medicine (Internal Medicine) Physician
549-025WIMDPodiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Dean Health Systems, Inc. CurrentSince Nov 1, 2014 Accepting new patients
Dean Health Systems, Inc CurrentSince Nov 1, 2014 Accepting new patients

Locations

1626 Tuttle St
Baraboo, WI 53913
Phone (608) 355-2033

1700 Tuttle St
Baraboo, WI 53913
Phone (608) 355-3800

825 Western Ave
Columbus, WI 53925
Phone (920) 623-2520

1808 W Beltline Hwy
Madison, WI 53713
Phone (608) 250-1497

515 22nd Ave
Monroe, WI 53566
Phone (608) 324-1000

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": "1146009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607040000000",
    "number": "1104883933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1626 TUTTLE ST",
            "city": "BARABOO",
            "state": "WI",
            "postal_code": "53913",
            "telephone_number": "608-355-6868",
            "fax_number": "608-355-7001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1626 TUTTLE ST",
            "city": "BARABOO",
            "state": "WI",
            "postal_code": "53913",
            "telephone_number": "608-355-6868",
            "fax_number": "608-355-7001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUSYK",
        "first_name": "BORYS",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-26",
        "last_updated": "2020-12-04",
        "certification_date": "2020-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "WI",
            "license": "549-025",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1104883933",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bkusyk261214@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "bkusyk261214@direct-ehr-ssmhc.com",
            "address_1": "1626 Tuttle St",
            "city": "Baraboo",
            "state": "WI",
            "country_code": "US",
            "postal_code": "53913",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "1626 Tuttle St",
            "city": "Baraboo",
            "state": "WI",
            "country_code": "US",
            "postal_code": "53913",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Baraboo, WI

Sources for this page

Verify at the official NPI Registry.