Bret Achterberg
Individual provider Active NPI Physical Therapist · Beaver Dam, WI
NPI 1467499830 · NPPES record last updated Jan 31, 2022
Key facts
- NPI
- 1467499830
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 6480-024 (WI)
- Practice address
- 134 Corporate Dr
Beaver Dam, WI 53916-3116 - Phone
- (920) 356-1000
- NPI assigned
- Jun 2, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 5
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 1999
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Prairie Ridge Health Inc
Practice addresses (Care Compare)
134 Corporate Dr
Beaver Dam, WI 53916-3116
Phone (920) 356-1000
1515 Park Ave
Columbus, WI 53925-1618
Phone (920) 623-2200
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060724000199 | WI | Practitioner - Physical Therapist in Private Practice | 4183637820 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6480 | WI | MD | Otolaryngology Physician |
| 6480-024 | WI | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prairie Ridge Health, Inc. | Current |
Accepting new patients | |
| Prairie Ridge Health Inc. | Current |
Accepting new patients | |
| Prairie Ridge Health, Inc. | Current |
Accepting new patients |
Locations
134 Corporate Dr
Beaver Dam, WI 53916
Phone (920) 356-1000
118 W Maple Ave
Beaver Dam, WI 53916
Phone (920) 356-1000
1515 Park Ave
Columbus, WI 53925
Phone (920) 623-1200
Interoperability endpoints
- https://fhir-myrecord.cerner.com/r4/a87187e5-fe2f-447e-bf32-4eeb3954a735/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 6480-024 | WI | Yes |
Addresses
Primary practice location
134 Corporate Dr
Beaver Dam, WI 53916-3116
Mailing address
1515 Park Ave
Columbus, WI 53925-2402
Phone (920) 623-2200
Other providers in Beaver Dam, WI
- Mesfin Taye Abera
- Abundance Acupuncture Inc.
- Bakir T Abushhiwa
- Advance Physical Therapy & Sports Rehab, LLC
- Advance Physical Therapy and Sports Rehab, LLC
- Advanced Pain Management SC
- Affiliated Counseling Center, Inc
- Agnesian Healthcare
All providers in Beaver Dam, WI · Physical Therapist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 31, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.