Individual provider Active NPI

Amy Nicole McMahon, OT

  • Occupational Therapist
  • De Pere, WI
National Provider Identifier
1396889648
Registry record updated Jul 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
4514 Issued in WI
Practice address
1686 Eisenhower Rd
De Pere, WI 54115-8145
Phone
(920) 496-4700
NPI assigned
Feb 19, 2007
Last updated
Jul 15, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 4514 WI Primary

Addresses

Primary practice location

1686 Eisenhower Rd
De Pere, WI 54115-8145

Mailing address

PO Box 19070
Green Bay, WI 54307-9070
Phone (920) 496-4700

Other practice location 1

1673 Dousman St
Green Bay, WI 54303-3209
Phone (920) 498-2599 ext. 381

Other names 1

  • Ms. Amy Nicole Reimer Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210727000922 WI Practitioner - Occupational Therapist in Private Practice 2163825209 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1686 Eisenhower Rd
De Pere, WI 54115-8145
Phone (920) 496-4700

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4514WIMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis CurrentSince Jul 1, 2021 Accepting new patients
St. Nicholas Hospital-Sisters of the Third Order of St Francis Occupational Therapist Current Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis Occupational Therapist CurrentSince Jul 1, 2021 Accepting new patients
St Nicholas Hospital-Sisters of the Third Order of St Francis CurrentSince Jul 1, 2021 Accepting new patients
St. Nicholas Hospital-Sisters of the Third Order of St Francis CurrentSince Jul 1, 2021 Accepting new patients

Locations

1601 Lawrence Dr
Ste 100
De Pere, WI 54115
Phone (920) 426-4700

1686 Eisenhower Rd
De Pere, WI 54115
Phone (920) 405-1493

1673 Dousman St
Green Bay, WI 54303
Phone (920) 498-2599

2900 Curry Ln
Green Bay, WI 54311
Phone (920) 468-1161

835 S Van Buren St
Green Bay, WI 54301
Phone (888) 901-7246

3100 Superior Ave
Sheboygan, WI 53081
Phone (800) 472-6710

Organizations & group practices 5

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": "1171843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626307200000",
    "number": "1396889648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19070",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543079070",
            "telephone_number": "920-496-4700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1686 EISENHOWER RD",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541158145",
            "telephone_number": "920-496-4700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1673 Dousman St",
            "address_purpose": "LOCATION",
            "city": "Green Bay",
            "state": "WI",
            "postal_code": "543033209",
            "country_code": "US",
            "telephone_number": "920-498-2599 x381",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCMAHON",
        "first_name": "AMY",
        "middle_name": "NICOLE",
        "name_prefix": "Mrs.",
        "credential": "OT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-19",
        "last_updated": "2021-07-15",
        "certification_date": "2021-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "WI",
            "license": "4514",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMY",
            "last_name": "REIMER",
            "middle_name": "NICOLE",
            "prefix": "MS.",
            "credential": "OT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in De Pere, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2021; 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.