Individual provider Active NPI

Amy Mannes, OTR

  • Occupational Therapist
  • Columbus, WI
National Provider Identifier
1194259291
Registry record updated Oct 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
6070-26 Issued in WI
Practice address
1515 Park Ave
Columbus, WI 53925-2402
Phone
(920) 623-2200
NPI assigned
Apr 14, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 6070-26 WI Primary

Addresses

Primary practice location

1515 Park Ave
Columbus, WI 53925-2402

Mailing address

1515 Park Ave
Columbus, WI 53925-2402
Phone (920) 623-2200

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221114002447 WI Practitioner - Occupational Therapist in Private Practice 0840668331 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Prairie Ridge Health IncGroup PAC ID 6800791484, 70 clinicians

Practice addresses (Care Compare)

1515 Park Ave
Columbus, WI 53925-1618
Phone (920) 623-2200

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6070-26WIMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Prairie Ridge Health, Inc. CurrentSince Sep 1, 2022 Accepting new patients
Prairie Ridge Health Inc. CurrentSince Sep 1, 2022 Accepting new patients
Aegis Group Practice LLC Occupational Therapist CurrentSince Sep 21, 2023 Accepting new patients
Prairie Ridge Health, Inc. Current Accepting new patients
Oasis Therapy Services LLC Occupational Therapist CurrentSince Aug 24, 2023 Accepting new patients
Aegis Group Practice LLC Occupational Therapist CurrentSince Sep 21, 2023 Accepting new patients
Aegis Group Practice LLC Occupational Therapist Current Accepting new patients

Locations

8170 McCormick Blvd
Ste 112
Skokie, IL 60076
Phone (920) 252-4442

1515 Park Ave
Columbus, WI 53925
Phone (920) 623-1200

Organizations & group practices 7

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": "1492128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666310400000",
    "number": "1194259291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 PARK AVE",
            "city": "COLUMBUS",
            "state": "WI",
            "postal_code": "539252402",
            "telephone_number": "920-623-2200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 PARK AVE",
            "city": "COLUMBUS",
            "state": "WI",
            "postal_code": "539252402",
            "telephone_number": "920-623-2200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANNES",
        "first_name": "AMY",
        "credential": "OTR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-14",
        "last_updated": "2022-10-21",
        "certification_date": "2022-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "WI",
            "license": "6070-26",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2022; 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.