Stefanie El-Darazi, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

12839-24 Issued in WI

Practice address

1224 Miller Pkway
West Milwaukee, WI 53214-3614

Phone

(414) 847-2971

Fax

(414) 645-8025

NPI assigned

Aug 21, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Stefanie Metka Former name

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Odom Sports Medicine PAGroup PAC ID 0143485607, 63 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Odom Sports Medicine, P.a.

  • Sports Medicine (Family Medicine) Physician
  • Eden Prairie, MN
  • NPI 1275557886
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1408579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410393600000",
    "number": "1235538653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909",
            "telephone_number": "630-296-2222",
            "fax_number": "630-759-6106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1224 MILLER PKWAY",
            "city": "WEST MILWAUKEE",
            "state": "WI",
            "postal_code": "532143614",
            "telephone_number": "414-847-2971",
            "fax_number": "414-645-8025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EL-DARAZI",
        "first_name": "STEFANIE",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-21",
        "last_updated": "2014-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "12839-24",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STEFANIE",
            "last_name": "METKA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Carrie Lee Cosgrove, RN
• Courtney Joanne Cveykus, SAC-IT
• Taria Daigle, LPN
• Michael Edward Druck, DDS
• Jennifer S Dubey, SAC-IT
• Family Transport LLC.,
• Shamika Marie Fitzgerald
• Sally Fongaro, RPH
• Aaron Foss
• Cory E Foster, RN

• Physical Therapist in West Milwaukee, WI
• Providers in West Milwaukee, WI by specialty
• Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2014; 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.