Individual provider Active NPI

Nicholas J Bisenius, PHD

  • Psychologist
  • Fort Atkinson, WI
National Provider Identifier
1619998747
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
596-057 Issued in WI
Practice address
509 McMillen St
Fort Atkinson, WI 53538-1263
Phone
(920) 563-7995
Fax
(920) 568-6047
NPI assigned
Jul 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 596-057 WI Primary

Addresses

Primary practice location

509 McMillen St
Fort Atkinson, WI 53538-1263

Mailing address

509 McMillen St
Fort Atkinson, WI 53538-1263
Phone (920) 563-7995

Other identifiers 1

IdentifierTypeStateIssuer
39005100MedicaidWI

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
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
596-057WIMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Catholic Charities Inc., Diocese of Madison Past Accepting new patients
Fort Healthcare Inc Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/8F7ruIta-JA7ecm4ommy-Q50dF1FkFe4/

Organizations & group practices 2

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": "1153526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1619998747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 MCMILLEN ST",
            "city": "FORT ATKINSON",
            "state": "WI",
            "postal_code": "535381263",
            "telephone_number": "920-563-7995",
            "fax_number": "920-568-6047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 MCMILLEN ST",
            "city": "FORT ATKINSON",
            "state": "WI",
            "postal_code": "535381263",
            "telephone_number": "920-563-7995",
            "fax_number": "920-568-6047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BISENIUS",
        "first_name": "NICHOLAS",
        "middle_name": "J",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WI",
            "license": "596-057",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39005100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Atkinson, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.