Individual provider Active NPI

Ryan J Smilanich, DPT

  • Physical Therapist
  • Oak Creek, WI
National Provider Identifier
1811619075
Registry record updated May 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
16103 Issued in WI
Practice address
200 E Ryan Rd
Oak Creek, WI 53154-4563
Phone
(414) 570-3590
Fax
(414) 570-3599
NPI assigned
Sep 14, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 10, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X
Physical Therapist 225100000X 16103 WI Primary

Addresses

Primary practice location

200 E Ryan Rd
Oak Creek, WI 53154-4563

Mailing address

PO Box 735044
Chicago, IL 60673-5044
Phone (414) 570-3590

Other practice location 1

8020 S Howell Ave
Oak Creek, WI 53154-2930
Phone (414) 647-3920

Other identifiers 1

IdentifierTypeStateIssuer
100224116MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address rsmilanich316696@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230123000964 WI Practitioner - Physical Therapist in Private Practice 4486025871 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lakeshore Medical Clinic LLCGroup PAC ID 7719890730, 375 clinicians

Practice addresses (Care Compare)

200 E Ryan Rd
Oak Creek, WI 53154-4563
Phone (414) 570-3590

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
16103WIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Ascension Medical Group-Southeast Wisconsin Inc CurrentSince Jan 9, 2023 Accepting new patients
Lakeshore Medical Clinic LTD CurrentSince Mar 10, 2023 Accepting new patients
Lakeshore Medical Clinic, LLC Physical Therapist CurrentSince Mar 10, 2023 Accepting new patients

Locations

13950 W Capitol Dr
Brookfield, WI 53005
Phone (414) 302-5400

S74W16775 Janesville Rd
Muskego, WI 53150
Phone (414) 422-4747

200 E Ryan Rd
Oak Creek, WI 53154
Phone (414) 570-3590

8020 S Howell Ave
Oak Creek, WI 53154
Phone (414) 647-3920

2000 E Layton Ave
St Francis, WI 53235
Phone (414) 744-7880

201 N Mayfair Rd
Fl 2
Wauwatosa, WI 53226
Phone (414) 771-8228

Interoperability endpoints

  • Direct secure messaging: rsmilanich316696@direct.myadvocateaurora.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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1663113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683676800000",
    "number": "1811619075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 735044",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606735044",
            "telephone_number": "414-570-3590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 E RYAN RD",
            "city": "OAK CREEK",
            "state": "WI",
            "postal_code": "531544563",
            "telephone_number": "414-570-3590",
            "fax_number": "414-570-3599"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8020 S Howell Ave",
            "address_purpose": "LOCATION",
            "city": "Oak Creek",
            "state": "WI",
            "postal_code": "531542930",
            "country_code": "US",
            "telephone_number": "414-647-3920",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMILANICH",
        "first_name": "RYAN",
        "middle_name": "J",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-09-14",
        "last_updated": "2023-05-10",
        "certification_date": "2023-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "16103",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100224116",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rsmilanich316696@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "200 E Ryan Rd",
            "city": "Oak Creek",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531544563",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "200 E Ryan Rd",
            "city": "Oak Creek",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531544563",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Oak Creek, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 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.