Misti D Fiddelke, MPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1761 Issued in NE

Practice address

321 Grand Ave
Ravenna, NE 68869-1321

Phone

(308) 452-7154

Fax

(308) 452-3394

NPI assigned

May 24, 2006

Last updated

Oct 24, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in NE

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Family Physical Therapy and Sports CenterGroup PAC ID 7214970177, 36 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

74.5 of 100Reported as individual

Quality

70

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Family Physical Therapy & Sports Center

  • Physical Therapist
  • Kearney, NE
  • NPI 1356373658
  Medicare reassignment Care Compare group NPD
• Family Physical Therapy & Sports Center

  dba Family Physical Therapy & Chiropractic Services

  • Chiropractor
  • Kearney, NE
  • NPI 1326551532
  NPD
• Family Physical Therapy & Sports Center

  • Physical Therapist
  • Ravenna, NE
  • NPI 1942417852
  NPD (past)

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666569600000",
    "number": "1629023031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "321 GRAND AVE",
            "city": "RAVENNA",
            "state": "NE",
            "postal_code": "688691321",
            "telephone_number": "308-452-7154",
            "fax_number": "308-452-3394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "321 GRAND AVE",
            "city": "RAVENNA",
            "state": "NE",
            "postal_code": "688691321",
            "telephone_number": "308-452-7154",
            "fax_number": "308-452-3394"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FIDDELKE",
        "first_name": "MISTI",
        "middle_name": "D",
        "credential": "MPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-24",
        "last_updated": "2022-10-24",
        "certification_date": "2022-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NE",
            "license": "1761",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "650024438",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "39601",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "470769316",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• City of Ravenna (Ravenna Emergency Unit)
• Michelle E. Clark, APRN
• Pamela Sue Dethlefs
• Family Physical Therapy & Sports Center
• Karalee Fiddelke, REGISTERED NURSE
• First Care Medical, PC
• Full Circle Dental (Ravenna Dental Clinic)
• Green Wave Counseling and Wellness
• Nancy J Hagan
• Richard Hagan

• Physical Therapist in Ravenna, NE
• Providers in Ravenna, NE by specialty
• Physical Therapist in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.