Individual provider Active NPI

Kevin M Huckstorf, DPT

  • Physical Therapist
  • Union Grove, WI
National Provider Identifier
1396438404
Registry record updated Jun 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
16298-24 Issued in WI
Practice address
1201 Main St
Union Grove, WI 53182-1372
Phone
(262) 878-9602
Fax
(262) 878-9609
NPI assigned
Jun 2, 2023
Last updated
Jun 2, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2023

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 16298-24 WI Primary

Addresses

Primary practice location

1201 Main St
Union Grove, WI 53182-1372

Mailing address

2122 York Rd Ste 300
Oak Brook, IL 60523-1925
Phone (630) 575-1980

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230614000928 WI Practitioner - Physical Therapist in Private Practice 6305204926 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Athletico LTDGroup PAC ID 4789602681, 2,187 clinicians

Practice addresses (Care Compare)

1201 Main St
Union Grove, WI 53182-1372
Phone (262) 878-9602

Merit-based Incentive Payment System (MIPS)

Final score
86.32 of 100Reported as group
Quality
84.44
Promoting interoperability
99
Improvement activities
40
Cost
70.78

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
16298-24WIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Athletico LTD Physical Therapist CurrentSince Jun 2, 2023 Accepting new patients
Athletico LTD Physical Therapist CurrentSince Jun 2, 2023 Accepting new patients

Locations

2122 York Rd
Ste 300
Oak Brook, IL 60523
Phone (630) 575-6250

5708 75th St
#B
Kenosha, WI 53142
Phone (262) 697-9135

2615 N Downer Ave
Milwaukee, WI 53211
Phone (414) 962-4400

1201 Main St
Union Grove, WI 53182
Phone (262) 878-9602

Interoperability endpoints

  • Direct secure messaging: kevin.huckstorf.p7@direct.athleticoltd.nextgenshare.com
  • Direct secure messaging: kevin.huckstorf.p9@direct.athleticoltd.nextgenshare.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1685664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685664000000",
    "number": "1396438404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2122 YORK RD STE 300",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605231925",
            "telephone_number": "630-575-1980",
            "fax_number": "630-928-5080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 MAIN ST",
            "city": "UNION GROVE",
            "state": "WI",
            "postal_code": "531821372",
            "telephone_number": "262-878-9602",
            "fax_number": "262-878-9609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUCKSTORF",
        "first_name": "KEVIN",
        "middle_name": "M",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-02",
        "last_updated": "2023-06-02",
        "certification_date": "2023-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "16298-24",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Union Grove, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2023; 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.