NPIMap

Organization Active NPI

Cerebral Palsy, Inc.

  • Rehabilitation Clinic/Center
  • Green Bay, WI
National Provider Identifier
1548216484
Registry record updated Mar 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
CEREBRAL PALSY, INC.
Practice address
2801 S Webster Ave
Green Bay, WI 54301-2878
Phone
(920) 337-1122
Fax
(920) 337-1126
NPI assigned
May 25, 2006
Last updated
Mar 10, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2022

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

Authorized official

Name
Mr. Jon Syndergaard
Title
Executive Director
Phone
(920) 337-1122

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Clinic/Center 261QR0400X NU Primary

Addresses

Primary practice location

2801 S Webster Ave
Green Bay, WI 54301-2878

Mailing address

2801 S Webster Ave
Billing Department
Green Bay, WI 54301-2878
Phone (920) 337-1122

Other identifiers 1

IdentifierTypeStateIssuer
41810300MedicaidWI

Other names 1

  • CP Center Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20090320000585 WI Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 0547327496 Practice locations: Green Bay, WI
O20180207001810 WI Part B Supplier - Clinic/Group Practice 0547327496 Receives reassigned benefits from 15 practitioners
Practice locations: Green Bay, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1548216484. Details of each certification follow.

  • CCN 526549 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 526549

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
CEREBRAL PALSY
Certification status
Active
Provider type (POS)
Outpatient physical therapy / speech pathology
Participating since
Apr 1, 1994
Last certification
Jun 26, 2023
Ownership / control type
Voluntary Non-Profit Other Than Church
Facility address
2801 S Webster Ave
Green Bay, WI 54301

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646870400000",
    "number": "1548216484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 S WEBSTER AVE",
            "address_2": "BILLING DEPARTMENT",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543012878",
            "telephone_number": "920-337-1122",
            "fax_number": "920-337-1126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 S WEBSTER AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543012878",
            "telephone_number": "920-337-1122",
            "fax_number": "920-337-1126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CEREBRAL PALSY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-25",
        "last_updated": "2022-03-10",
        "certification_date": "2022-03-10",
        "status": "A",
        "authorized_official_last_name": "SYNDERGAARD",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "920-337-1122",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41810300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CP Center",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "CP Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.