John Richard Reiskytl, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

30968 Issued in WI

Practice address

1205 North Ave
Cleveland VA Cboc
Cleveland, WI 53015-1413

Phone

(920) 693-5600

NPI assigned

Jul 20, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1841210150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1205 NORTH AVE",
            "address_2": "CLEVELAND VA CBOC",
            "city": "CLEVELAND",
            "state": "WI",
            "postal_code": "530151413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 NORTH AVE",
            "address_2": "CLEVELAND VA CBOC",
            "city": "CLEVELAND",
            "state": "WI",
            "postal_code": "530151413",
            "telephone_number": "920-693-5600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REISKYTL",
        "first_name": "JOHN",
        "middle_name": "RICHARD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "30968",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Milwaukee Vamc
• Doris Misiak, LMSW
• Nathan Nitka, RD, CD
• Carrie Lynne Oakley, REGISTERED NURSE
• Jamie Lauren Olsen, RD
• Michael James Sheridan, R.N.
• TSS Equipment Company

• Family Medicine Physician in Cleveland, WI
• Providers in Cleveland, WI by specialty
• Family Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.