Sara Formankiewicz, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

2000 N Dewey Ave
Reedsburg, WI 53959-1049

Phone

(608) 768-3900

NPI assigned

Oct 10, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Sara Busskohl Former name

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Monroe Clinic, Inc.Group PAC ID 3072425495, 199 clinicians

Mercy Health System CorporationGroup PAC ID 7416860440, 749 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mercy Health System Corp Hospital, Janesville, WI, CCN 520066
• The Monroe Clinic Hospital, Monroe, WI, CCN 520028

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sformankiewicz96697@direct.mhemail.org
• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
• FHIR API: https://api.platform.athenahealth.com/9971/brand/1/csg/1/fhir/r4

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.

• Mercy Health System Corporation

  • Multi-Specialty Clinic/Center
  • Janesville, WI
  • NPI 1598718603

  WI

  Medicare reassignment Care Compare group NPD
• The Monroe Clinic, Inc.

  • Specialist
  • Monroe, WI
  • NPI 1386720548

  WI

  Medicare reassignment Care Compare group NPD
• Reedsburg Area Medical Center, Inc.

  • Critical Access Hospital
  • Reedsburg, WI
  • NPI 1891796710

  WI

  Medicare reassignment NPD
• Mercy Health System Corporation

  • General Acute Care Hospital
  • Janesville, WI
  • NPI 1093768962
  Care Compare group NPD
• Mercy Health System Corporation

  • Critical Access Hospital
  • Lake Geneva, WI
  • NPI 1699728550
  Care Compare group NPD
• The Monroe Clinic, Inc.

  • General Acute Care Hospital
  • Monroe, WI
  • NPI 1740291491
  Care Compare group NPD
• Sauk Prairie Healthcare Inc

  • General Acute Care Hospital
  • Prairie Du Sac, WI
  • NPI 1861466153

  WI

  Medicare reassignment
• Mercy Health System Corporation

  • Prosthetic/Orthotic Supplier
  • Lake Geneva, WI
  • NPI 1710124698
  Care Compare group NPD (past)
• Mercy Health System Corporation

  • Pharmacy
  • Milton, WI
  • NPI 1013953504
  Care Compare group
• Mercy Health System Corporation

  • Chronic Disease Hospital
  • Janesville, WI
  • NPI 1164588679
  Care Compare group
• Mercy Health System Corporation

  • Skilled Nursing Facility
  • Janesville, WI
  • NPI 1427105006
  Care Compare group
• Mercy Health System Corporation

  • Pharmacy
  • Janesville, WI
  • NPI 1467498857
  Care Compare group

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Mercy Health System Corporation

  • General Acute Care Hospital
  • Janesville, WI
  • NPI 1093768962

  Hospital

  Care Compare affiliation
• The Monroe Clinic, Inc.

  • General Acute Care Hospital
  • Monroe, WI
  • NPI 1740291491

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1476057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678406400000",
    "number": "1467902874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 N DEWEY AVE",
            "city": "REEDSBURG",
            "state": "WI",
            "postal_code": "539591049",
            "telephone_number": "608-768-3900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 N DEWEY AVE",
            "city": "REEDSBURG",
            "state": "WI",
            "postal_code": "539591049",
            "telephone_number": "608-768-3900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "515 22nd Ave",
            "address_purpose": "LOCATION",
            "city": "Monroe",
            "state": "WI",
            "postal_code": "535661569",
            "country_code": "US",
            "telephone_number": "608-324-1000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FORMANKIEWICZ",
        "first_name": "SARA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-10",
        "last_updated": "2023-03-10",
        "certification_date": "2023-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "3930",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sformankiewicz419794@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "sformankiewicz419794@direct-ehr-ssmhc.com",
            "address_1": "515 22nd Ave",
            "city": "Monroe",
            "state": "WI",
            "country_code": "US",
            "postal_code": "535661569",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://webproxyprd.monroeclinic.org/FHIR-PRD/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "515 22nd Ave",
            "city": "Monroe",
            "state": "WI",
            "country_code": "US",
            "postal_code": "535661569",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "SARA",
            "last_name": "BUSSKOHL",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Everside Health-Land'S End Reedsburg
• Paul Kevin Fernholz, R.PH.
• Kathryn Michele Fitzpatrick, MSE, LPC, NCC
• Sheenah Marie Fitzpatrick, COTA
• Danielle Fleischmann, PHARMD
• Daniel Thomas Frey
• Nathan C Fritsch, CRNA
• Racheal Mayes Fuller, FNP-C
• Bryn Gahm, DPT
• Elizabeth Gale, MS, OTR/L

• All providers in Reedsburg, WI
• Physician Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.