Individual provider Active NPI

Dane Schultz

  • Family Nurse Practitioner
  • Fort Atkinson, WI
National Provider Identifier
1649933748
Registry record updated Dec 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
11311-11 Issued in WI
Practice address
611 Sherman Ave E
Fort Atkinson, WI 53538-1960
Phone
(920) 563-5571
NPI assigned
Oct 16, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 11311-11 WI Primary

Addresses

Primary practice location

611 Sherman Ave E
Fort Atkinson, WI 53538-1960

Mailing address

PO Box 249
Fort Atkinson, WI 53538-0249
Phone (920) 568-6580

Other practice location 1

1461 W Main St
Whitewater, WI 53190-1568
Phone (262) 473-5888

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211201000083 WI Practitioner - Nurse Practitioner 6901296227 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fort Healthcare IncGroup PAC ID 0840189718, 159 clinicians

Practice addresses (Care Compare)

611 Sherman Ave E
Fort Atkinson, WI 53538-1960
Phone (920) 563-5571

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11311-11WIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Fort Healthcare Inc CurrentSince Dec 27, 2021 Accepting new patients
Fort Healthcare Inc CurrentSince Dec 27, 2021 Accepting new patients
Fort Healthcare, Inc. Past Accepting new patients

Locations

611 Sherman Ave E
Fort Atkinson, WI 53538
Phone (920) 563-6667

500 McMillen St
Fort Atkinson, WI 53538
Phone (920) 563-5571

1461 W Main St
Whitewater, WI 53190
Phone (262) 472-6839

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/8F7ruIta-JA7ecm4ommy-Q50dF1FkFe4/
  • Direct secure messaging: dane.schultz@direct.forthc.com

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 and National Provider Directory roles.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1634342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765929600000",
    "number": "1649933748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 249",
            "city": "FORT ATKINSON",
            "state": "WI",
            "postal_code": "535380249",
            "telephone_number": "920-568-6580",
            "fax_number": "920-568-4004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 SHERMAN AVE E",
            "city": "FORT ATKINSON",
            "state": "WI",
            "postal_code": "535381960",
            "telephone_number": "920-563-5571"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1461 W Main St",
            "address_purpose": "LOCATION",
            "city": "Whitewater",
            "state": "WI",
            "postal_code": "531901568",
            "country_code": "US",
            "telephone_number": "262-473-5888",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SCHULTZ",
        "first_name": "DANE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-10-16",
        "last_updated": "2025-12-17",
        "certification_date": "2025-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "11311-11",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Atkinson, WI

Sources for this page

Verify at the official NPI Registry.