Desiree Lynn Demcak, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

16871 Issued in WI

Practice address

1821 S Stoughton Rd
Madison, WI 53716-2257

Phone

(608) 260-6000

Fax

(608) 260-6906

NPI assigned

Jan 5, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Desiree Lynn Frederick Former name

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ddemcak509697@direct-ehr-ssmhc.com

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.

• Dean Health Systems, Inc

  • Allergy & Immunology Physician
  • Madison, WI
  • NPI 1053358846
  Medicare reassignment NPD
• Dean Health Systems, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Portage, WI
  • NPI 1427085679
  NPD

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

{
    "created_epoch": "1609804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720396800000",
    "number": "1639767718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1821 S STOUGHTON RD",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537162257",
            "telephone_number": "608-260-6000",
            "fax_number": "608-260-6906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1821 S STOUGHTON RD",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537162257",
            "telephone_number": "608-260-6000",
            "fax_number": "608-260-6906"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "501 State St N",
            "address_purpose": "LOCATION",
            "city": "Waseca",
            "state": "MN",
            "postal_code": "560932811",
            "country_code": "US",
            "telephone_number": "507-835-3110",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9220 Bass Lake Rd Ste 260",
            "address_purpose": "LOCATION",
            "city": "New Hope",
            "state": "MN",
            "postal_code": "554283019",
            "country_code": "US",
            "telephone_number": "763-533-0363",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1025 Marsh St",
            "address_purpose": "LOCATION",
            "city": "Mankato",
            "state": "MN",
            "postal_code": "560014752",
            "country_code": "US",
            "telephone_number": "507-781-8146",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEMCAK",
        "first_name": "DESIREE",
        "middle_name": "LYNN",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-05",
        "last_updated": "2024-07-08",
        "certification_date": "2024-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "12097",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "16871",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1639767718",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "1821 S Stoughton Rd",
            "city": "Madison",
            "state": "WI",
            "country_code": "US",
            "postal_code": "537162257",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ddemcak509697@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "ddemcak509697@direct-ehr-ssmhc.com",
            "address_1": "1821 S Stoughton Rd",
            "city": "Madison",
            "state": "WI",
            "country_code": "US",
            "postal_code": "537162257",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "DESIREE",
            "last_name": "FREDERICK",
            "middle_name": "LYNN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jill M. Deluca, PA
• Frances Ann Delzer, RN
• Katlyn J Demain, LPC, MS
• Dean M Demarais, PA-C
• Laura Demarzo, PSY.D
• Marina Demenech, LCSW
• Michelle Demeo
• Paula Demetrio de Souza Franca, MD
• Angela I. Demeuse, RN
• Dustin A Deming, M.D.

• Physical Therapist in Madison, WI
• Providers in Madison, WI by specialty
• Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2024; 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.