Individual provider Active NPI

Catherine Van Lare, PT, DPT

  • Physical Therapist
  • Mequon, WI
National Provider Identifier
1154127447
Registry record updated Apr 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
17089-24 Issued in WI
Practice address
10725 N Executive CT
Mequon, WI 53092-4602
Phone
(262) 329-4555
NPI assigned
Feb 19, 2025
Last updated
Apr 8, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2025

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 17089-24 WI Primary

Addresses

Primary practice location

10725 N Executive CT
Mequon, WI 53092-4602

Mailing address

PO Box 735044
Chicago, IL 60673-5044
Phone (800) 326-2250

Other practice location 1

750 W Virginia St
Milwaukee, WI 53204-1539
Phone (888) 863-5502

Other identifiers 1

IdentifierTypeStateIssuer
100309025MedicaidWI

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250307001511 WI Practitioner - Physical Therapist in Private Practice 4789105669 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians

Practice addresses (Care Compare)

9000 W Sura LN
Greenfield, WI 53228-3477
Phone (414) 246-6800

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
17089-24WIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeshore Medical Clinic, LLC Physical Therapist CurrentSince Mar 1, 2025 Accepting new patients
Aurora Advanced Healthcare, Inc. CurrentSince Mar 1, 2025 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Mar 1, 2025 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Mar 1, 2025 Accepting new patients
Aurora Advanced Healthcare Inc CurrentSince Mar 1, 2025 Accepting new patients

Locations

3003 W Good Hope Rd
Glendale, WI 53209
Phone (414) 352-3100

215 Washington St
Grafton, WI 53024
Phone (262) 375-3700

10725 N Executive Ct
Mequon, WI 53092
Phone (262) 329-4555

12203 N Corporate Pkwy
Mequon, WI 53092
Phone (262) 387-8200

1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056

3305 S 20th St
Milwaukee, WI 53215
Phone (414) 384-2100

9000 W Sura Ln
Milwaukee, WI 53228
Phone (414) 246-6500

S74W16775 Janesville Rd
Muskego, WI 53150
Phone (414) 422-4747

2000 E Layton Ave
St Francis, WI 53235
Phone (414) 744-7880

Organizations & group practices 5

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": "1739923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744070400000",
    "number": "1154127447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 735044",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606735044",
            "telephone_number": "800-326-2250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10725 N EXECUTIVE CT",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530924602",
            "telephone_number": "262-329-4555"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "750 W Virginia St",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532041539",
            "country_code": "US",
            "telephone_number": "888-863-5502",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VAN LARE",
        "first_name": "CATHERINE",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-02-19",
        "last_updated": "2025-04-08",
        "certification_date": "2025-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "17089-24",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100309025",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "10725 N Executive Ct",
            "city": "Mequon",
            "state": "WI",
            "country_code": "US",
            "postal_code": "530924602",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mequon, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2025; 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.