Individual provider Active NPI

Korl C. Bomkamp, DPT

  • Physical Therapist
  • Janesville, WI
National Provider Identifier
1205568912
Registry record updated Jun 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
15855-24 Issued in WI
Practice address
3524 E Milwaukee St
Janesville, WI 53546-1626
Phone
(608) 756-7100
Fax
(608) 756-7225
NPI assigned
Jun 30, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2022

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 15855-24 WI Primary

Addresses

Primary practice location

3524 E Milwaukee St
Janesville, WI 53546-1626

Mailing address

3524 E Milwaukee St
Janesville, WI 53546-1626
Phone (608) 756-7100

Other practice location 1

N2950 State Road 67
Lake Geneva, WI 53147-2655
Phone (262) 245-4990

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220823000267 WI Practitioner - Physical Therapist in Private Practice 8022491174 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
15855-24WIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health System Corporation Current Accepting new patients
Mercy Health System Corporation CurrentSince Jun 27, 2022 Accepting new patients
Mercy Health System Corporation CurrentSince Jun 27, 2022 Accepting new patients

Locations

29624 Network Pl
Chicago, IL 60673
Phone (608) 741-7652

1000 Mineral Point Ave
Janesville, WI 53548
Phone (608) 261-6868

3524 E Milwaukee St
Janesville, WI 53546
Phone (608) 756-7100

N2950 State Road 67
Lake Geneva, WI 53147
Phone (262) 245-0535

Organizations & group practices 3

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": "1656547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656547200000",
    "number": "1205568912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3524 E MILWAUKEE ST",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535461626",
            "telephone_number": "608-756-7100",
            "fax_number": "608-756-7225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3524 E MILWAUKEE ST",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535461626",
            "telephone_number": "608-756-7100",
            "fax_number": "608-756-7225"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "N2950 State Road 67",
            "address_purpose": "LOCATION",
            "city": "Lake Geneva",
            "state": "WI",
            "postal_code": "531472655",
            "country_code": "US",
            "telephone_number": "262-245-4990",
            "fax_number": "262-245-2248",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOMKAMP",
        "first_name": "KORL",
        "middle_name": "C.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-30",
        "last_updated": "2022-06-30",
        "certification_date": "2022-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "15855-24",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Janesville, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2022; 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.