Individual provider Active NPI

Stacey Depies, DPT

  • Physical Therapist
  • Columbus, WI
National Provider Identifier
1598210247
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
13583 Issued in WI
Practice address
1515 Park Ave
Columbus, WI 53925-1618
Phone
(920) 623-2200
NPI assigned
Aug 23, 2016
Last updated
Mar 17, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 13583 WI Primary

Addresses

Primary practice location

1515 Park Ave
Columbus, WI 53925-1618

Mailing address

1515 Park Ave
Columbus, WI 53925-1618
Phone (920) 623-2200

Other practice location 1

614 Memorial Dr
Chilton, WI 53014-1568
Phone (920) 849-2386

Other practice location 2

614 Memorial Dr
Chilton, WI 53014-1568
Phone (920) 849-2386

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170113001720 WI Practitioner - Physical Therapist in Private Practice 0648552224 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
13583WIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Prairie Ridge Health, Inc. Current Accepting new patients
Prairie Ridge Health, Inc. CurrentSince Oct 9, 2017 Accepting new patients
Prairie Ridge Health Inc. CurrentSince Oct 9, 2017 Accepting new patients

Locations

1515 Park Ave
Columbus, WI 53925
Phone (920) 623-1200

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1471910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1598210247",
    "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": "1515 PARK AVE",
            "city": "COLUMBUS",
            "state": "WI",
            "postal_code": "539251618",
            "telephone_number": "920-623-2200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "614 Memorial Dr",
            "address_purpose": "LOCATION",
            "city": "Chilton",
            "state": "WI",
            "postal_code": "530141568",
            "country_code": "US",
            "telephone_number": "920-849-2386",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "614 Memorial Dr",
            "address_purpose": "LOCATION",
            "city": "Chilton",
            "state": "WI",
            "postal_code": "530141568",
            "country_code": "US",
            "telephone_number": "920-849-2386",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEPIES",
        "first_name": "STACEY",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-23",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "13583",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.

Verify at the official NPI Registry.