Individual provider Active NPI

Corey B Wolf, P.T.

  • Physical Therapist
  • Mequon, WI
National Provider Identifier
1508897208
Registry record updated Dec 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
9670 Issued in WI
Practice address
10725 N Executive CT
Mequon, WI 53092-4602
Phone
(262) 388-6262
NPI assigned
Jul 5, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2021

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 9670 WI Primary

Addresses

Primary practice location

10725 N Executive CT
Mequon, WI 53092-4602

Mailing address

3301 W Forest Home Ave
Milwaukee, WI 53215-2843
Phone (262) 329-4555

Other practice location 1

12203 Corporate Pkwy
Mequon, WI 53092-3388
Phone (262) 387-8200

Other identifiers 1

IdentifierTypeStateIssuer
40360000MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address cwolf1013@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040304001062 WI Practitioner - Physical Therapist in Private Practice 0345138186 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aurora Advanced Healthcare, Inc.Group PAC ID 3375625833, 1,107 clinicians

Practice addresses (Care Compare)

10725 N Executive CT
Mequon, WI 53092-4602
Phone (262) 329-4555

12203 N Corporate Pkwy
Mequon, WI 53092-3388
Phone (262) 387-8200

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
9670WIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Medical Group, Inc. CurrentSince Feb 25, 2024 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Feb 25, 2024 Accepting new patients
Aurora Medical Group, Inc. Current Accepting new patients
Aurora Advanced Healthcare Inc CurrentSince Jan 1, 2008 Accepting new patients
Lakeshore Medical Clinic LTD CurrentSince Apr 30, 2024 Accepting new patients
Lakeshore Medical Clinic, LLC Physical Therapist CurrentSince Apr 30, 2024 Accepting new patients
Aurora Advanced Healthcare, Inc. CurrentSince Jan 1, 2008 Accepting new patients
Advanced Healthcare SC Past Accepting new patients

Locations

3003 W Good Hope Rd
Glendale, WI 53209
Phone (414) 352-3100

12203 N Corporate Pkwy
Mequon, WI 53092
Phone (262) 387-8200

10725 N Executive Ct
Mequon, WI 53092
Phone (262) 329-4555

9000 W Sura Ln
Milwaukee, WI 53228
Phone (414) 246-6500

7878 N 76th St
Milwaukee, WI 53223
Phone (414) 354-6434

3301 W Forest Home Ave
Milwaukee, WI 53215
Phone (414) 389-2233

1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056

S74W16775 Janesville Rd
Muskego, WI 53150
Phone (414) 422-4747

200 E Ryan Rd
Oak Creek, WI 53154
Phone (414) 570-3590

2000 E Layton Ave
St Francis, WI 53235
Phone (414) 744-7880

Interoperability endpoints

  • Direct secure messaging: cwolf1013@direct.myadvocateaurora.org

Organizations & group practices 8

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": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640736000000",
    "number": "1508897208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3301 W FOREST HOME AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532152843",
            "telephone_number": "262-329-4555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10725 N EXECUTIVE CT",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530924602",
            "telephone_number": "262-388-6262"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12203 Corporate Pkwy",
            "address_purpose": "LOCATION",
            "city": "Mequon",
            "state": "WI",
            "postal_code": "530923388",
            "country_code": "US",
            "telephone_number": "262-387-8200",
            "fax_number": "262-387-8271",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WOLF",
        "first_name": "COREY",
        "middle_name": "B",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-05",
        "last_updated": "2021-12-29",
        "certification_date": "2021-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "9670",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40360000",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cwolf1013@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "12203 Corporate Pkwy",
            "city": "Mequon",
            "state": "WI",
            "country_code": "US",
            "postal_code": "530923388",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "12203 Corporate Pkwy",
            "city": "Mequon",
            "state": "WI",
            "country_code": "US",
            "postal_code": "530923388",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mequon, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 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.