Active NPI
Steve Ellmann
- Rehabilitation Psychologist
- Dousman, WI
National Provider Identifier
1801060199
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Psychologist
- Practice address
- W350S1401 Waterville Rd
Dousman, WI 53118-9020 - Phone
- (262) 965-2131
- NPI assigned
- Apr 17, 2008
- Last updated
- Apr 17, 2008
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Rehabilitation Psychologist | 103TR0400X | NU | Primary |
Addresses
Primary practice location
W350S1401 Waterville Rd
Dousman, WI 53118-9020
Mailing address
W350S1401 Waterville Rd
Dousman, WI 53118-9020
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39717300 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lad Lake, Inc. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Emotionally Disturbed Childrens' Residential Treatment Facility
- Dousman, WI
- NPI 1114196854
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1208390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1208390400000",
"number": "1801060199",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "W350S1401 WATERVILLE RD",
"city": "DOUSMAN",
"state": "WI",
"postal_code": "531189020"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "W350S1401 WATERVILLE RD",
"city": "DOUSMAN",
"state": "WI",
"postal_code": "531189020",
"telephone_number": "262-965-2131"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLMANN",
"first_name": "STEVE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-04-17",
"last_updated": "2008-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "103TR0400X",
"taxonomy_group": "",
"desc": "Psychologist, Rehabilitation",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "39717300",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dousman, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.