NPIMap

Individual provider Active NPI

Adam Wied, DPT

  • Physical Therapist
  • Green Bay, WI
National Provider Identifier
1124408174
Registry record updated Jun 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
12994-024 Issued in WI
Practice address
1727 Shawano Ave
Green Bay, WI 54303-3268
Phone
(920) 272-3380
NPI assigned
Jun 4, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2015

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 12994-024 WI Primary

Addresses

Primary practice location

1727 Shawano Ave
Green Bay, WI 54303-3268

Mailing address

1727 Shawano Ave
Green Bay, WI 54303-3268

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150625002724 WI Practitioner - Physical Therapist in Private Practice 3971814344 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Vincent Hospital-Hospital Sisters-Third Order of St Francis 593 clinicians

Practice addresses (Care Compare)

1727 Shawano Ave
Green Bay, WI 54303-3268
Phone (920) 496-4700

Merit-based Incentive Payment System (MIPS)

Final score
94.81 of 100Reported as apm
Quality
85.98
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12994-024WIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis Physical Therapist CurrentSince Jun 8, 2015 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis CurrentSince Jun 8, 2015 Accepting new patients
St Nicholas Hospital-Sisters of the Third Order of St Francis CurrentSince Oct 29, 2020 Accepting new patients
St Nicholas Hospital-Sisters of the Third Order of St Francis CurrentSince Oct 29, 2020 Accepting new patients
St. Nicholas Hospital-Sisters of the Third Order of St Francis Physical Therapist Current Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis Past Accepting new patients

Locations

3860 Monroe Rd
De Pere, WI 54115
Phone (920) 272-1200

835 S Van Buren St
Green Bay, WI 54301
Phone (888) 901-7246

1727 Shawano Ave
Green Bay, WI 54303
Phone (920) 431-1810

3100 Superior Ave
Sheboygan, WI 53081
Phone (800) 472-6710

Organizations & group practices 19

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.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1433376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433376000000",
    "number": "1124408174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1727 SHAWANO AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543033268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1727 SHAWANO AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543033268",
            "telephone_number": "920-272-3380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIED",
        "first_name": "ADAM",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-04",
        "last_updated": "2015-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "12994-024",
            "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 4, 2015; 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.