Individual provider Active NPI

Anne Marie Gongola, D.P.T.

  • Physical Therapist
  • Greenfield, WI
National Provider Identifier
1669637708
Registry record updated Jun 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
11044-024 Issued in WI
Practice address
9000 W Sura LN
Greenfield, WI 53228-3477
Phone
(414) 246-6500
NPI assigned
Jul 28, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 12, 2024

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 11044-024 WI Primary

Addresses

Primary practice location

9000 W Sura LN
Greenfield, WI 53228-3477

Mailing address

PO Box 735044
Chicago, IL 60673-5044
Phone (800) 326-2250

Other identifiers 1

IdentifierTypeStateIssuer
100257112MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address agongola359229@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231122001231 WI Practitioner - Physical Therapist in Private Practice 4789032228 Reassigns benefits to 4 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11044-024WIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Advanced Healthcare, Inc. CurrentSince Apr 28, 2024 Accepting new patients
Midwest Orthopedic Specialty Hospital, LLC CurrentSince Nov 13, 2023 Accepting new patients
Lakeshore Medical Clinic, LLC Physical Therapist CurrentSince Apr 28, 2024 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Apr 28, 2024 Accepting new patients
Midwest Orthopedic Specialty Hospital, LLC Current Accepting new patients
Midwest Orthopedic Specialty Hospital, LLC CurrentSince Nov 13, 2023 Accepting new patients
Aurora Advanced Healthcare Inc CurrentSince Apr 28, 2024 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Apr 28, 2024 Accepting new patients

Locations

7095 S Ballpark Dr
Unit 100
Franklin, WI 53132
Phone (414) 817-6620

3003 W Good Hope Rd
Glendale, WI 53209
Phone (414) 352-3100

12203 N Corporate Pkwy
Mequon, WI 53092
Phone (262) 387-8200

9000 W Sura Ln
Milwaukee, WI 53228
Phone (414) 246-6500

3305 S 20th St
Milwaukee, WI 53215
Phone (414) 384-2100

1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056

S74W16775 Janesville Rd
Muskego, WI 53150
Phone (414) 422-4747

2000 E Layton Ave
St Francis, WI 53235
Phone (414) 744-7880

11415 W Burleigh St
Ste 109
Wauwatosa, WI 53222
Phone (414) 239-9547

Organizations & group practices 8

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": "1217203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718150400000",
    "number": "1669637708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 735044",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606735044",
            "telephone_number": "800-326-2250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9000 W SURA LN",
            "city": "GREENFIELD",
            "state": "WI",
            "postal_code": "532283477",
            "telephone_number": "414-246-6500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONGOLA",
        "first_name": "ANNE",
        "middle_name": "MARIE",
        "credential": "D.P.T.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-07-28",
        "last_updated": "2024-06-12",
        "certification_date": "2024-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "11044-024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100257112",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "agongola359229@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "9000 W Sura Ln",
            "city": "Greenfield",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532283477",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "9000 W Sura Ln",
            "city": "Greenfield",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532283477",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Greenfield, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 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.