Pain Centers of Wisconsin - Fort Atkinson, LLC

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

Legal business name

PAIN CENTERS OF WISCONSIN - FORT ATKINSON, LLC

Practice address

1604 Madison Ave
Fort Atkinson, WI 53538-3101

Phone

(920) 568-6596

Fax

(920) 568-9429

NPI assigned

Jan 25, 2012

Last updated

Oct 7, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

John Bartell

Title

Director/Privacy Officer

Phone

(920) 568-6558

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Listed as

Pain Centers of Wisconsin Fort Atkinson LLCCCN 52C0001097

Medicare certification status

Terminated Voluntary: merger or closure, Jan 26, 2021From the Provider of Services file

Locations

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

{
    "created_epoch": "1327449600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665100800000",
    "number": "1316218167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 660",
            "city": "FORT ATKINSON",
            "state": "WI",
            "postal_code": "535380660",
            "telephone_number": "920-568-9429",
            "fax_number": "920-568-9429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1604 MADISON AVE",
            "city": "FORT ATKINSON",
            "state": "WI",
            "postal_code": "535383101",
            "telephone_number": "920-568-6596",
            "fax_number": "920-568-9429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAIN CENTERS OF WISCONSIN - FORT ATKINSON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-25",
        "last_updated": "2022-10-07",
        "certification_date": "2022-10-07",
        "status": "A",
        "authorized_official_last_name": "BARTELL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "DIRECTOR/PRIVACY OFFICER",
        "authorized_official_telephone_number": "920-568-6558"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100176317",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Opportunities, Inc. of Jefferson County
• Orthopaedic Associates LTD
• Abigail Osborn, RN
• Eugene E Ott, PA-C
• PA Smith LLC (Visiting Angels Fort Atkinson)
• Pain Centers of Wisconsin - Fort Atkinson, LLC
• Kristen R Parkinson, R.N.
• Mary Katherine Parrott, PT, DPT
• Peak Endurance PT LLC
• Pamela Mary Pennycooke

• Interventional Pain Medicine Physician in Fort Atkinson, WI
• Providers in Fort Atkinson, WI by specialty
• Interventional Pain Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 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.