Elizabeth J Basak, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

10319-024 Issued in WI

Practice address

1630 Commanche Ave
Green Bay, WI 54313-5753

Phone

(920) 430-4750

NPI assigned

Jun 13, 2007

Last updated

Nov 22, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Baycare Aurora LLCGroup PAC ID 0244130557, 197 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Baycare Aurora, LLC

  • General Acute Care Hospital
  • Green Bay, WI
  • NPI 1255387726
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1181692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637539200000",
    "number": "1679777650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22487",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543052487",
            "telephone_number": "920-445-7226",
            "fax_number": "920-445-7229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1630 COMMANCHE AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543135753",
            "telephone_number": "920-430-4750"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1580 Commanche Ave",
            "address_purpose": "LOCATION",
            "city": "Green Bay",
            "state": "WI",
            "postal_code": "543135751",
            "country_code": "US",
            "telephone_number": "920-435-8326",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "964 W Ryan St Ste B",
            "address_purpose": "LOCATION",
            "city": "Brillion",
            "state": "WI",
            "postal_code": "541101077",
            "country_code": "US",
            "telephone_number": "920-756-2055",
            "fax_number": "920-756-3350",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "595 ounty Road R",
            "address_purpose": "LOCATION",
            "city": "Denmark",
            "state": "WI",
            "postal_code": "542089198",
            "country_code": "US",
            "telephone_number": "920-863-2005",
            "fax_number": "920-863-6416",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "744 S Webster Ave",
            "address_purpose": "LOCATION",
            "city": "Green Bay",
            "state": "WI",
            "postal_code": "543013505",
            "country_code": "US",
            "telephone_number": "920-433-7822",
            "fax_number": "920-433-3651",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3263 Eaton Rd",
            "address_purpose": "LOCATION",
            "city": "Green Bay",
            "state": "WI",
            "postal_code": "543116830",
            "country_code": "US",
            "telephone_number": "920-433-6700",
            "fax_number": "920-433-6719",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BASAK",
        "first_name": "ELIZABETH",
        "middle_name": "J",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-13",
        "last_updated": "2021-11-22",
        "certification_date": "2021-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "10319-024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40450700",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ebasak308427@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "744 S Webster Ave",
            "city": "Green Bay",
            "state": "WI",
            "country_code": "US",
            "postal_code": "543013505",
            "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": "744 S Webster Ave",
            "city": "Green Bay",
            "state": "WI",
            "country_code": "US",
            "postal_code": "543013505",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Mary Lynn Bartel, MD
• Gregory Bartell, LPC
• Angela Bartels, OTR
• Douglas A Bartelt, APNP
• Michelle Lee Barth, MA, LPC
• Ashlie Basche
• Celestina Bassett, NP
• Kathryn L Bassett, QTT
• Subash Bastakoti, M.D.
• Shane Bastar, SAC-IT

• Physical Therapist in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2021; 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.