Individual provider Active NPI

Shanie L Williams, PT

  • Physical Therapist
  • Green Bay, WI
National Provider Identifier
1699750612
Registry record updated Dec 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
6505 Issued in WI
Practice address
3263 Eaton Road
Green Bay, WI 54311-8046
Phone
(920) 433-6700
Fax
(920) 433-6769
NPI assigned
Dec 13, 2005
Last updated
Dec 30, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2022

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 6505 WI Primary

Addresses

Primary practice location

3263 Eaton Road
Green Bay, WI 54311-8046

Mailing address

PO Box 22487
Green Bay, WI 54305-2487
Phone (920) 445-7210

Other practice location 1

744 S Webster Ave
Green Bay, WI 54301-3505
Phone (920) 433-7822

Other practice location 2

1970 S Ridge Rd
Green Bay, WI 54304-4125
Phone (920) 430-4888

Other practice location 3

1580 Commanche Ave
Green Bay, WI 54313-5751
Phone (920) 435-8326

Other names 1

  • Shanie L Polasik Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040326000572 WI Practitioner - Physical Therapist in Private Practice 2567354350 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bellin Memorial Hospital IncGroup PAC ID 8820900749, 685 clinicians

Practice addresses (Care Compare)

744 S Webster Ave
Green Bay, WI 54301-3505
Phone (920) 433-6025

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6505WIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Bellin Memorial Hospital Inc Physical Therapist CurrentSince Nov 3, 2014 Accepting new patients
Bellin Memorial Hospital Inc Current Accepting new patients
Bellin Memorial Hospital CurrentSince Nov 3, 2014 Accepting new patients

Locations

235 E Ryan St
Brillion, WI 54110
Phone (920) 756-2055

1580 Commanche Ave
Green Bay, WI 54313
Phone (920) 431-5687

2305 San Luis Pl
Green Bay, WI 54304
Phone (920) 494-2817

3263 Eaton Rd
Green Bay, WI 54311
Phone (920) 433-6000

744 S Webster Ave
Green Bay, WI 54301
Phone (920) 433-6025

575 4th St
Kewaunee, WI 54216
Phone (920) 388-4640

405 Commercial St
Seymour, WI 54165
Phone (920) 833-2318

Interoperability endpoints

  • Direct secure messaging: spolasik32308@direct.thedacare.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1134432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672358400000",
    "number": "1699750612",
    "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": "920-445-7210",
            "fax_number": "920-445-7289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3263 EATON ROAD",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543118046",
            "telephone_number": "920-433-6700",
            "fax_number": "920-433-6769"
        }
    ],
    "practiceLocations": [
        {
            "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": "1970 S Ridge Rd",
            "address_purpose": "LOCATION",
            "city": "Green Bay",
            "state": "WI",
            "postal_code": "543044125",
            "country_code": "US",
            "telephone_number": "920-430-4888",
            "fax_number": "920-430-4889",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "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"
        }
    ],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "SHANIE",
        "middle_name": "L",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-13",
        "last_updated": "2022-12-30",
        "certification_date": "2022-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "6505",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANIE",
            "last_name": "POLASIK",
            "middle_name": "L",
            "credential": "PT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Green Bay, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2022; 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.