Active NPI
Micheal E Ceizyk, PT
- Orthopedic Physical Therapist
- Beaver Dam, WI
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopedic Physical Therapist
- License
- 6203
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40349200 | Medicaid | WI | |
| 1034219 | Other | WI | PHYSICIANS PLUS |
| P00064733 | Other | WI | RAILROAD MEDICARE |
| 61271 | Other | WI | DEAN HEALTH SYSTEMS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6203 | WI | MD | Nurse Practitioner |
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 | |
| 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
- 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.
-
- Critical Access Hospital
- Columbus, WI
- NPI 1154403657
-
- Family Medicine Physician
- Sun Prairie, WI
- NPI 1699534545
-
- Orthopaedic Surgery Physician
- Beaver Dam, WI
- NPI 1093137416
-
- Specialist
- Beaver Dam, WI
- NPI 1467565978
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.