Individual provider Active NPI

Raymond J Koziol, PHD

  • Psychologist
  • Sun Prairie, WI
National Provider Identifier
1447286653
Registry record updated Mar 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
1850-057 Issued in WI
Practice address
10 Tower Dr
Dean Medical Center
Sun Prairie, WI 53590-1239
Phone
(608) 825-3008
Fax
(608) 825-3794
NPI assigned
Jun 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 1850-057 WI Primary

Addresses

Primary practice location

10 Tower Dr
Dean Medical Center
Sun Prairie, WI 53590-1239

Mailing address

10 Tower Dr
Dean Medical Center
Sun Prairie, WI 53590-1239
Phone (608) 825-3008

Other identifiers 2

IdentifierTypeStateIssuer
39752600MedicaidWI
4729OtherWIDEAN HEALTH INSURANCE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100618000819 WI Practitioner - Clinical Psychologist 4284764127 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Psychology Center S CGroup PAC ID 6507857463, 27 clinicians

Practice addresses (Care Compare)

7617 Mineral Point Rd
Suite 300
Madison, WI 53717-1623
Phone (608) 833-9290

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
1850-057WIMDPsychologist
1850WIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The Psychology Center S C CurrentSince Sep 1, 2012 Accepting new patients

Locations

7617 Mineral Point Rd
Madison, WI 53717
Phone (608) 833-9290

7617 Mineral Point Rd
Ste 300
Madison, WI 53717
Phone (608) 833-9290

Organizations & group practices 1

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": "1151020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1268006400000",
    "number": "1447286653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 TOWER DR",
            "address_2": "DEAN MEDICAL CENTER",
            "city": "SUN PRAIRIE",
            "state": "WI",
            "postal_code": "535901239",
            "telephone_number": "608-825-3008",
            "fax_number": "608-825-3794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 TOWER DR",
            "address_2": "DEAN MEDICAL CENTER",
            "city": "SUN PRAIRIE",
            "state": "WI",
            "postal_code": "535901239",
            "telephone_number": "608-825-3008",
            "fax_number": "608-825-3794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOZIOL",
        "first_name": "RAYMOND",
        "middle_name": "J",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-23",
        "last_updated": "2010-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WI",
            "license": "1850-057",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39752600",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEAN HEALTH INSURANCE",
            "identifier": "4729",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sun Prairie, WI

Sources for this page

Verify at the official NPI Registry.