NPIMap

Organization Active NPI

Imagine a Child'S Capacity

  • Rehabilitation Clinic/Center
  • Fitchburg, WI
National Provider Identifier
1770688970
Registry record updated Mar 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
IMAGINE A CHILD'S CAPACITY
Practice address
2875 Fish Hatchery Rd
Fitchburg, WI 53713-3114
Phone
(608) 204-6242
Fax
(608) 204-6249
NPI assigned
Sep 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2012

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

Authorized official

Name
Mr. David Johnson, CEO.
Title
Executive Director.
Phone
(608) 316-1127

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 104100000X
Pediatric Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 2251P0200X
Speech/Language/Hearing Specialist/TechnologistGroup: 193200000X MULTI-SPECIALTY GROUP 235500000X
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X WI
In Home Supportive Care Agency 253Z00000X WI
Rehabilitation Clinic/Center 261QR0400X WI Primary

Addresses

Primary practice location

2875 Fish Hatchery Rd
Fitchburg, WI 53713-3114

Mailing address

2875 Fish Hatchery Rd
Fitchburg, WI 53713-3114
Phone (608) 204-6242

Other identifiers 1

IdentifierTypeStateIssuer
41225100MedicaidWI

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332806400000",
    "number": "1770688970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2875 FISH HATCHERY RD",
            "city": "FITCHBURG",
            "state": "WI",
            "postal_code": "537133114",
            "telephone_number": "608-204-6242",
            "fax_number": "608-204-6249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2875 FISH HATCHERY RD",
            "city": "FITCHBURG",
            "state": "WI",
            "postal_code": "537133114",
            "telephone_number": "608-204-6242",
            "fax_number": "608-204-6249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMAGINE A CHILD'S CAPACITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-13",
        "last_updated": "2012-03-27",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR.",
        "authorized_official_telephone_number": "608-316-1127",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CEO."
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251P0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist/Technologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "WI",
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "WI",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41225100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fitchburg, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.