Active NPI
Alyssa Anne Gloudemans, P.T.
- Physical Therapist
- Oshkosh, WI
National Provider Identifier
1689128365
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 13586-24
- Practice address
- 500 S Oakwood Rd
Oshkosh, WI 54904-7944 - Phone
- (920) 738-2000
- NPI assigned
- Aug 10, 2016
- Last updated
- Jan 31, 2020
- 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 | 13586-24 | WI | Primary |
Addresses
Primary practice location
500 S Oakwood Rd
Oshkosh, WI 54904-7944
Mailing address
2420 Lupine CT
Menasha, WI 54952-8917
Phone (920) 810-4737
Other practice location 1
325 E Florida Ave
Appleton, WI 54911-1325
Phone (920) 731-7310
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240604003384 | WI | Practitioner - Physical Therapist in Private Practice | 4688116775 |
Care Compare profile
Medicare Care Compare- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2016
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
1335 Stranssner Dr
Brentwood, MO 63144-1872
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13586-24 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1470787200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1580428800000",
"number": "1689128365",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2420 LUPINE CT",
"city": "MENASHA",
"state": "WI",
"postal_code": "549528917",
"telephone_number": "920-810-4737"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 S OAKWOOD RD",
"city": "OSHKOSH",
"state": "WI",
"postal_code": "549047944",
"telephone_number": "920-738-2000"
}
],
"practiceLocations": [
{
"address_1": "325 E Florida Ave",
"address_purpose": "LOCATION",
"city": "Appleton",
"state": "WI",
"postal_code": "549111325",
"country_code": "US",
"telephone_number": "920-731-7310",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GLOUDEMANS",
"first_name": "ALYSSA",
"middle_name": "ANNE",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-08-10",
"last_updated": "2020-01-31",
"certification_date": "2020-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "13586-24",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oshkosh, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2020; 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.