Active NPI
Mary Susan Walters, PT
- Physical Therapist
- Sun Prairie, WI
National Provider Identifier
1669619110
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2461-024
- Practice address
- 10 Tower Dr
Sun Prairie, WI 53590-1239 - Phone
- (608) 825-3516
- Fax
- (608) 825-3598
- NPI assigned
- Jan 20, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2461-024 | WI | Primary |
Addresses
Primary practice location
10 Tower Dr
Sun Prairie, WI 53590-1239
Mailing address
10 Tower Dr
Sun Prairie, WI 53590-1239
Phone (608) 825-3516
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| FHIR URL | https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ | Other | |
| Direct Messaging Address | mwalters262800@direct-ehr-ssmhc.com | Direct |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2461-024 | WI | MD | Physical Therapist |
| 2461 | WI | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1232409600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1607990400000",
"number": "1669619110",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 TOWER DR",
"city": "SUN PRAIRIE",
"state": "WI",
"postal_code": "535901239",
"telephone_number": "608-825-3516",
"fax_number": "608-825-3598"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 TOWER DR",
"city": "SUN PRAIRIE",
"state": "WI",
"postal_code": "535901239",
"telephone_number": "608-825-3516",
"fax_number": "608-825-3598"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALTERS",
"first_name": "MARY SUSAN",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-01-20",
"last_updated": "2020-12-15",
"certification_date": "2020-12-15",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "2461-024",
"primary": true
}
],
"identifiers": [],
"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": "10 Tower Dr",
"city": "Sun Prairie",
"state": "WI",
"country_code": "US",
"postal_code": "535901239",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "mwalters262800@direct-ehr-ssmhc.com",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "mwalters262800@direct-ehr-ssmhc.com",
"address_1": "10 Tower Dr",
"city": "Sun Prairie",
"state": "WI",
"country_code": "US",
"postal_code": "535901239",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Sun Prairie, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.