Individual provider Active NPI

Mackenzie Jensen Wheeler, DPT

  • Physical Therapist
  • Mequon, WI
National Provider Identifier
1639760044
Registry record updated Dec 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
10620 N Port Washington Rd Ste 202
Mequon, WI 53092-5048
Phone
(414) 351-5794
NPI assigned
Jan 28, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2023

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 Primary

Addresses

Primary practice location

10620 N Port Washington Rd Ste 202
Mequon, WI 53092-5048

Mailing address

790 Remington Blvd
Bolingbrook, IL 60440-4909

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210312000200 WI Practitioner - Physical Therapist in Private Practice 0749696979 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orthopaedic Associates of Wisconsin SCGroup PAC ID 1052200953, 106 clinicians

Practice addresses (Care Compare)

N15W28300 Golf Rd
Pewaukee, WI 53072-4800
Phone (262) 303-5055

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Athletic & Therapeutic Institute of Milwaukee, LLC Physical Therapist CurrentSince Jul 14, 2023 Accepting new patients
Athletic & Therapeutic Institute of Milwaukee, LLC Physical Therapist Current Accepting new patients
Orthopaedic Associates of Wisconsin SC CurrentSince Feb 13, 2023 Accepting new patients
Orthopaedic Associates of Wisconsin, SC CurrentSince Feb 13, 2023 Accepting new patients
Athletic & Therapeutic Institute of Milwaukee, LLC Physical Therapist CurrentSince Jul 14, 2023 Accepting new patients

Locations

790 Remington Blvd
Bolingbrook, IL 60440

285 S Moorland Rd
Brookfield, WI 53005
Phone (810) 331-0939

S74W16867 Janesville Rd
Muskego, WI 53150
Phone (262) 971-4200

N15W28300 Golf Rd
Pewaukee, WI 53072

Organizations & group practices 5

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": "1611792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702944000000",
    "number": "1639760044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10620 N PORT WASHINGTON RD STE 202",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530925048",
            "telephone_number": "414-351-5794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHEELER",
        "first_name": "MACKENZIE",
        "middle_name": "JENSEN",
        "name_prefix": "Dr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-01-28",
        "last_updated": "2023-12-19",
        "certification_date": "2023-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mequon, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2023; 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.