Pai Participant 23 SC

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

Legal business name

PAI PARTICIPANT 23 SC

Practice address

1475 Birch Hill LN
Shawano, WI 54166-3707

Phone

(715) 526-3161

NPI assigned

Sep 22, 2020

Last updated

Aug 13, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Brittain Brantley

Title

Acting President

Phone

(302) 300-5138

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1600732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1786579200000",
    "number": "1528674801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 639676",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452639676",
            "telephone_number": "859-291-4800",
            "fax_number": "859-655-8588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1475 BIRCH HILL LN",
            "city": "SHAWANO",
            "state": "WI",
            "postal_code": "541663707",
            "telephone_number": "715-526-3161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAI PARTICIPANT 23 SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-22",
        "last_updated": "2026-08-13",
        "certification_date": "2026-08-13",
        "status": "A",
        "authorized_official_last_name": "BRANTLEY",
        "authorized_official_first_name": "BRITTAIN",
        "authorized_official_title_or_position": "ACTING PRESIDENT",
        "authorized_official_telephone_number": "302-300-5138"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jill Olsen, APNP
• Orthopedic & Spine Therapy of Clintonville, SC
• Orthopedic & Spine Therapy of Clintonville, SC
• Matthew James Osborne, PT
• Kirby Elizabeth Otto, APNP
• Ann M Papendorf, APNP
• Angela M Parmentier, DNP, APNP, NP-C, RN-
• Paul D. Dibley, D.D.S., S.C.
• Emma Pavletich
• Tyler Pensis

• Geriatric Medicine (Internal Medicine) Physician in Shawano, WI
• Providers in Shawano, WI by specialty
• Geriatric Medicine (Internal Medicine) Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.