Individual provider Active NPI

Michael Alexander Wilshusen, DPT

  • Physical Therapist
  • Sedalia, MO
National Provider Identifier
1760079958
Registry record updated May 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2020025989 Issued in MO
Practice address
115 W Broadway Blvd Ste 300
Sedalia, MO 65301-5708
Phone
(660) 827-2942
NPI assigned
Dec 22, 2020
Last updated
May 27, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 27, 2023

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

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiopulmonary Physical Therapist 2251C2600X
Ergonomics Physical Therapist 2251E1200X
Clinical Electrophysiology Physical Therapist 2251E1300X
Geriatric Physical Therapist 2251G0304X
Hand Physical Therapist 2251H1200X
Human Factors Physical Therapist 2251H1300X
Neurology Physical Therapist 2251N0400X
Sports Physical Therapist 2251S0007X
Orthopedic Physical Therapist 2251X0800X
Physical Therapist 225100000X 2020025989 MO Primary

Addresses

Primary practice location

115 W Broadway Blvd Ste 300
Sedalia, MO 65301-5708

Mailing address

1200 Corporate Dr Ste 400
Hoover, AL 35242-5424
Phone (423) 238-7217

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230707002362 MO Practitioner - Physical Therapist in Private Practice 1456710565 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Serc Rebabilitation Partners, LLCGroup PAC ID 9830344563, 212 clinicians

Practice addresses (Care Compare)

115 W Broadway Blvd
Suite 300
Sedalia, MO 65301-5708
Phone (660) 827-2945

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2020025989MOMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Serc Rebabilitation Partners, LLC Physical Therapist CurrentSince May 30, 2023 Accepting new patients
Serc Rehabilitation Partners, LLC Physical Therapist CurrentSince May 30, 2023 Accepting new patients

Locations

1200 Corporate Dr
Ste 400
Hoover, AL 35242
Phone (423) 238-7568

1225 SW State Route 7
Blue Springs, MO 64014
Phone (816) 295-2051

109 W Franklin St
Clinton, MO 64735
Phone (660) 383-1280

115 W Broadway Blvd
Ste 300
Sedalia, MO 65301
Phone (660) 827-2942

Organizations & group practices 2

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": "1608595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685145600000",
    "number": "1760079958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 CORPORATE DR STE 400",
            "city": "HOOVER",
            "state": "AL",
            "postal_code": "352425424",
            "telephone_number": "423-238-7217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 W BROADWAY BLVD STE 300",
            "city": "SEDALIA",
            "state": "MO",
            "postal_code": "653015708",
            "telephone_number": "660-827-2942"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSHUSEN",
        "first_name": "MICHAEL",
        "middle_name": "ALEXANDER",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-12-22",
        "last_updated": "2023-05-27",
        "certification_date": "2023-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251C2600X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Cardiopulmonary",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251E1200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Ergonomics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251E1300X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Electrophysiology, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251G0304X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Geriatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251H1200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Hand",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251H1300X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Human Factors",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251N0400X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Neurology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251S0007X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Sports",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "2020025989",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sedalia, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2023; 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.