Active NPI
Elise M Wallgren, PT
- Physical Therapist
- Greenfield, WI
National Provider Identifier
1184356883
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 15889
- Practice address
- 9000 W Sura LN
Greenfield, WI 53228-3477 - Phone
- (414) 246-6800
- Fax
- (414) 246-6405
- NPI assigned
- Jun 30, 2022
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 15889 | WI | Primary |
Addresses
Primary practice location
9000 W Sura LN
Greenfield, WI 53228-3477
Mailing address
3301 W Forest Home Ave
Milwaukee, WI 53215-2843
Phone (414) 246-6800
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100205207 | Medicaid | WI |
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | ewallgren326462@direct.myadvocateaurora.org | Direct | |
| FHIR URL | https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/ |
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1656547200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1659571200000",
"number": "1184356883",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3301 W FOREST HOME AVE",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532152843",
"telephone_number": "414-246-6800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9000 W SURA LN",
"city": "GREENFIELD",
"state": "WI",
"postal_code": "532283477",
"telephone_number": "414-246-6800",
"fax_number": "414-246-6405"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLGREN",
"first_name": "ELISE",
"middle_name": "M",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-06-30",
"last_updated": "2022-08-04",
"certification_date": "2022-08-04",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "15889",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100205207",
"state": "WI"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "ewallgren326462@direct.myadvocateaurora.org",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "9000 W Sura Ln",
"city": "Greenfield",
"state": "WI",
"country_code": "US",
"postal_code": "532283477",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "FHIR",
"endpointTypeDescription": "FHIR URL",
"endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
"affiliation": "N",
"address_1": "9000 W Sura Ln",
"city": "Greenfield",
"state": "WI",
"country_code": "US",
"postal_code": "532283477",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Greenfield, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.