Forward Ketamine of Wisconsin S.C.

Primary specialty

Infusion Therapy Clinic/CenterTaxonomy code 261QI0500X

Legal business name

FORWARD KETAMINE OF WISCONSIN S.C.

Practice address

221 King St
Madison, WI 53703-3419

Phone

(608) 898-4818

NPI assigned

Apr 6, 2023

Organization subpart

No

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

Authorized official

Name

Matthew VaseyNPI 1982075313

Title

President

Phone

(608) 898-4818

Specialties & licenses 1

Addresses

Other names 1

• Forward Ketamine Doing business as

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Matthew Joseph Vasey

  • Family Nurse Practitioner
  • Madison, WI
  • NPI 1982075313
  Medicare reassignment NPD Authorized official
• Brian R. Czapko, APN

  • Family Nurse Practitioner
  • Downers Grove, IL
  • NPI 1245793488

  WI

  Medicare reassignment NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1680739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680739200000",
    "number": "1194410142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 KING ST",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537033419",
            "telephone_number": "608-898-4818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 KING ST",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537033419",
            "telephone_number": "608-898-4818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORWARD KETAMINE OF WISCONSIN S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-06",
        "last_updated": "2023-04-06",
        "certification_date": "2023-04-06",
        "status": "A",
        "authorized_official_last_name": "VASEY",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "608-898-4818"
    },
    "taxonomies": [
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Forward Ketamine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lynn Toni Fortner, M.S., CCC-A
• Rachel Marie Fortney, FNP-BC
• Forto Transportation Services
• Jennifer Fortune, MSW
• Forum Extended Care Services of Wisconsin Inc
• Forward Psychology Group
• Forward Psychology Group, LLC
• Megan Rose Foss, DNP, APNP
• Avery Fossum
• Stephanie J Fossum, NP

• Infusion Therapy Clinic/Center in Madison, WI
• Providers in Madison, WI by specialty
• Infusion Therapy Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.