Individual provider Active NPI

Diego Villarreal, PT

  • Physical Therapist
  • Milwaukee, WI
National Provider Identifier
1154090785
Registry record updated Jun 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
15435-24 Issued in WI
Practice address
1032 S Cesar E Chavez Dr
Milwaukee, WI 53204-2203
Phone
(414) 672-1353
NPI assigned
Sep 8, 2021
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 27, 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 15435-24 WI Primary

Addresses

Primary practice location

1032 S Cesar E Chavez Dr
Milwaukee, WI 53204-2203

Mailing address

PO Box 778789
Chicago, IL 60677-8789
Phone (414) 672-1353

Other practice location 1

7901 S 6th St
Oak Creek, WI 53154-2010
Phone (262) 532-8300

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL Epic Health Information Exchange (HIE)

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211012001852 WI Practitioner - Physical Therapist in Private Practice 6800294463 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
16TH Street Community Health Center Inc.Group PAC ID 6709876857, 83 clinicians

Practice addresses (Care Compare)

309 E N St
Waukesha, WI 53188-3718
Phone (414) 672-1353

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
15435-24WIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Sixteenth Street Community Health Centers, Inc. Physical Therapist CurrentSince Jun 1, 2023 Accepting new patients
The Medical College of Wisconsin, Inc. Physical Therapist Current Accepting new patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. CurrentSince Jul 3, 2021 Accepting new patients
Sixteenth Street Community Health Centers, Inc. CurrentSince Jun 1, 2023 Accepting new patients
16TH Street Community Health Center Inc. Physical Therapist Current Accepting new patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. CurrentSince Jul 3, 2021 Accepting new patients
16TH Street Community Health Center Inc. Physical Therapist Past Accepting new patients
Sixteenth Street Community Health Centers, Inc. Physical Therapist Past Accepting new patients

Locations

21700 Intertech Dr
Brookfield, WI 53045
Phone (262) 532-8300

W168N11237 Western Ave
Germantown, WI 53022
Phone (262) 253-5060

2906 S 20th St
Milwaukee, WI 53215
Phone (414) 385-8800

1635 W National Ave
Milwaukee, WI 53204
Phone (262) 408-5094

1032 S Cesar E Chavez Dr
Milwaukee, WI 53204

4570 S 27th St
Milwaukee, WI 53221
Phone (414) 325-8720

7901 S 6th St
Oak Creek, WI 53154
Phone (414) 346-8000

309 E North St
Waukesha, WI 53188
Phone (262) 408-2530

1155 N Mayfair Rd
Wauwatosa, WI 53226
Phone (414) 955-5990

Organizations & group practices 8

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": "1631059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687824000000",
    "number": "1154090785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 778789",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606778789",
            "telephone_number": "414-672-1353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1032 S CESAR E CHAVEZ DR",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532042203",
            "telephone_number": "414-672-1353"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7901 S 6th St",
            "address_purpose": "LOCATION",
            "city": "Oak Creek",
            "state": "WI",
            "postal_code": "531542010",
            "country_code": "US",
            "telephone_number": "262-532-8300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VILLARREAL",
        "first_name": "DIEGO",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-09-08",
        "last_updated": "2023-06-27",
        "certification_date": "2023-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "15435-24",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "Epic",
            "affiliation": "N",
            "endpointDescription": "Can be used to communicate between providers, between providers and patients",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "21700 Intertech Dr",
            "city": "Brookfield",
            "state": "WI",
            "country_code": "US",
            "postal_code": "530455197",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 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.