Individual provider Active NPI

Micheal E Ceizyk, PT

  • Orthopedic Physical Therapist
  • Beaver Dam, WI
National Provider Identifier
1508979972
Registry record updated Feb 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
6203 Issued in WI
Practice address
134 Corporate Dr
Beaver Dam, WI 53916-3116
Phone
(920) 356-1000
Fax
(920) 356-0719
NPI assigned
Aug 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic Physical Therapist 2251X0800X 6203 WI Primary

Addresses

Primary practice location

134 Corporate Dr
Beaver Dam, WI 53916-3116

Mailing address

1515 Park Ave
Columbus, WI 53925-1618
Phone (920) 623-2200

Other identifiers 4

IdentifierTypeStateIssuer
40349200MedicaidWI
1034219OtherWIPHYSICIANS PLUS
P00064733OtherWIRAILROAD MEDICARE
61271OtherWIDEAN HEALTH SYSTEMS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050114000343 WI Practitioner - Physical Therapist in Private Practice 0042269276 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6203WIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Prairie Ridge Health Inc. CurrentSince Apr 1, 2014 Accepting new patients
Prairie Ridge Health, Inc. Current Accepting new patients
Prairie Ridge Health, Inc. CurrentSince Apr 1, 2014 Accepting new patients
Family & Sports Orthopaedic Center, LLC Past 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

825 Western Ave
Columbus, WI 53925
Phone (920) 623-2520

1515 Park Ave
Columbus, WI 53925
Phone (920) 623-1200

1511 Park Ave
Columbus, WI 53925
Phone (920) 623-3012

620 W Brown St
Waupun, WI 53963
Phone (920) 324-5581

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/a87187e5-fe2f-447e-bf32-4eeb3954a735/

Organizations & group practices 4

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": "1155772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645056000000",
    "number": "1508979972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 PARK AVE",
            "city": "COLUMBUS",
            "state": "WI",
            "postal_code": "539251618",
            "telephone_number": "920-623-2200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 CORPORATE DR",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539163116",
            "telephone_number": "920-356-1000",
            "fax_number": "920-356-0719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CEIZYK",
        "first_name": "MICHEAL",
        "middle_name": "E",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-17",
        "last_updated": "2022-02-17",
        "certification_date": "2022-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "WI",
            "license": "6203",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40349200",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIANS PLUS",
            "identifier": "1034219",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00064733",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEAN HEALTH SYSTEMS",
            "identifier": "61271",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaver Dam, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.