Active NPI
Phillip Stutzman, BCBA
- Behavior Analyst
- Brookfield, WI
National Provider Identifier
1124533914
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 201-140
- Practice address
- 4125 N 124TH St Ste a
Brookfield, WI 53005-1837 - Phone
- (414) 763-2341
- NPI assigned
- Dec 3, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 201-140 | WI | Primary |
Addresses
Primary practice location
4125 N 124TH St Ste a
Brookfield, WI 53005-1837
Mailing address
6720 W English Meadows Dr Apt K104
Greenfield, WI 53220-3978
Phone (414) 828-7778
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100050272 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 201-140 | WI | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1512259200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1512259200000",
"number": "1124533914",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6720 W ENGLISH MEADOWS DR APT K104",
"city": "GREENFIELD",
"state": "WI",
"postal_code": "532203978",
"telephone_number": "414-828-7778"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4125 N 124TH ST STE A",
"city": "BROOKFIELD",
"state": "WI",
"postal_code": "530051837",
"telephone_number": "414-763-2341"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STUTZMAN",
"first_name": "PHILLIP",
"credential": "BCBA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-12-03",
"last_updated": "2017-12-03",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "WI",
"license": "201-140",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100050272",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brookfield, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.