NPIMap

Individual provider Active NPI

Guillermo Miguel Valenzuela Cortez, MD

  • Internal Medicine Physician
  • Johnson Creek, WI
National Provider Identifier
1710597174
Registry record updated Sep 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
83885-20 Issued in WI
Practice address
400 Doctors CT
Johnson Creek, WI 53038-9567
Phone
(920) 699-4245
Fax
(920) 699-4748
NPI assigned
Jul 31, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MT222042 PA
Student in an Organized Health Care Education/Training Program 390200000X MT222042 PA
Internal Medicine Physician 207R00000X 83885-20 WI Primary

Addresses

Primary practice location

400 Doctors CT
Johnson Creek, WI 53038-9567

Mailing address

PO Box 249
Fort Atkinson, WI 53538-0249
Phone (920) 563-4466

Other practice location 1

205 S Front St Ste 3C
Harrisburg, PA 17104-1619
Phone (717) 231-8532

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240807000444 WI Practitioner - Internal Medicine 5092252155 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fort Healthcare IncGroup PAC ID 0840189718, 159 clinicians

Practice addresses (Care Compare)

400 Doctors CT
Johnson Creek, WI 53038-9567
Phone (920) 699-4245

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue292
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
83885-20WIMDInternal Medicine Physician
MT222042PAMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Fort Healthcare, Inc. CurrentSince Sep 9, 2024 Accepting new patients
Fort Healthcare Inc Current Accepting new patients
Fort Healthcare Inc CurrentSince Sep 9, 2024 Accepting new patients

Locations

611 Sherman Ave E
Fort Atkinson, WI 53538
Phone (920) 563-6667

400 Doctors Ct
Johnson Creek, WI 53038
Phone (920) 699-4000

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/8F7ruIta-JA7ecm4ommy-Q50dF1FkFe4/

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 and National Provider Directory roles.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1596153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727049600000",
    "number": "1710597174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 249",
            "city": "FORT ATKINSON",
            "state": "WI",
            "postal_code": "535380249",
            "telephone_number": "920-563-4466",
            "fax_number": "920-568-4004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 DOCTORS CT",
            "city": "JOHNSON CREEK",
            "state": "WI",
            "postal_code": "530389567",
            "telephone_number": "920-699-4245",
            "fax_number": "920-699-4748"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "205 S Front St Ste 3C",
            "address_purpose": "LOCATION",
            "city": "Harrisburg",
            "state": "PA",
            "postal_code": "171041619",
            "country_code": "US",
            "telephone_number": "717-231-8532",
            "fax_number": "717-231-8535",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VALENZUELA CORTEZ",
        "first_name": "GUILLERMO",
        "middle_name": "MIGUEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-07-31",
        "last_updated": "2024-09-23",
        "certification_date": "2024-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MT222042",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "PA",
            "license": "MT222042",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "83885-20",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson Creek, WI

Sources for this page

Verify at the official NPI Registry.