Carolyn Jansen, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

13571-24 Issued in WI

Practice address

5300 Memorial Dr
Aurora Rehabilitation Center
Two Rivers, WI 54241

Phone

(920) 312-1992

NPI assigned

Dec 23, 2016

Last updated

Aug 21, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Carolyn Keller Former name

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physical Medicine and Rehabilitation

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sport Clinic Physical Therapy IncGroup PAC ID 0244285187, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Sport Clinic Physical Therapy Inc

  • Physical Therapist
  • Bayside, WI
  • NPI 1912918475
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1482451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534809600000",
    "number": "1568907772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5300 MEMORIAL DR",
            "address_2": "AURORA REHABILITATION CENTER",
            "city": "TWO RIVERS",
            "state": "WI",
            "postal_code": "542413923",
            "telephone_number": "920-312-1992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5300 MEMORIAL DR",
            "address_2": "AURORA REHABILITATION CENTER",
            "city": "TWO RIVERS",
            "state": "WI",
            "postal_code": "54241",
            "telephone_number": "920-312-1992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JANSEN",
        "first_name": "CAROLYN",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-12-23",
        "last_updated": "2018-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "13571-24",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CAROLYN",
            "last_name": "KELLER",
            "credential": "PT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Erin B Humphrey, DO
• Patricia Huston, CRNA
• Amber Hutchison, LPC-IT
• Nadine M Illichmann, DC
• Ahmed Inam-Ul-Haq, MD
• Brian Charles Jensen, RPH
• Abigail Rose Johnson, PHARM.D
• Arthur Jordan, CHIROPRACTOR
• Lindsey M Kalcich, PA
• Jaclyn Karbon, PTA

• Physical Therapist in Two Rivers, WI
• Providers in Two Rivers, WI by specialty
• Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.