Individual provider Active NPI

Jeffrey P Sischo, DPT, LAT, PT

  • Athletic Trainer
  • Waukesha, WI
National Provider Identifier
1588657902
Registry record updated Nov 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Athletic TrainerTaxonomy code 2255A2300X
License
137-039 Issued in WI
Practice address
100 N East Ave
PT Building, #116
Waukesha, WI 53186-3103
Phone
(262) 951-3049
NPI assigned
Aug 31, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic Trainer 2255A2300X 137-039 WI Primary
Physical Therapist 225100000X 10699-024 WI

Addresses

Primary practice location

100 N East Ave
PT Building, #116
Waukesha, WI 53186-3103

Mailing address

3121 E Diane Dr
Oak Creek, WI 53154-3483
Phone (414) 570-1450

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10699-024WIMDPhysical Therapist
137-039WIMDAthletic Trainer

Practice roles

OrganizationSpecialtyStatusNew patients
Athletic & Therapeutic Institute of Milwaukee, LLC Physical Therapist PastSince Mar 30, 2018 Accepting new patients
Chad Novasic PT LTD Physical Therapist Past Accepting new patients
Peak Performance Sports Medicine, LLC Past Accepting new patients

Organizations & group practices 3

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": "1125446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480377600000",
    "number": "1588657902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3121 E DIANE DR",
            "city": "OAK CREEK",
            "state": "WI",
            "postal_code": "531543483",
            "telephone_number": "414-570-1450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 N EAST AVE",
            "address_2": "PT BUILDING, #116",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531863103",
            "telephone_number": "262-951-3049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SISCHO",
        "first_name": "JEFFREY",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "DPT, LAT, PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-31",
        "last_updated": "2016-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "WI",
            "license": "137-039",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "10699-024",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waukesha, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2016; 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.