Active NPI
Sundance Rehabilitation LLC
- Rehabilitation Clinic/Center
- Greenfield, WI
National Provider Identifier
1841245701
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Clinic/Center
- Legal business name
- SUNDANCE REHABILITATION LLC
- Practice address
- 3933 S Prairie Hill LN
C/O Hickory Park
Greenfield, WI 53228-2371 - Phone
- (414) 546-3371
- Fax
- (847) 360-9311
- NPI assigned
- May 22, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ian Oppel
- Title
- Coo
- Phone
- (980) 254-7007
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Clinic/Center | 261QR0400X | Primary |
Addresses
Primary practice location
3933 S Prairie Hill LN
C/O Hickory Park
Greenfield, WI 53228-2371
Mailing address
101 E State St
Kennett Square, PA 19348-3109
Phone (610) 925-4560
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 41811700 | Medicaid | WI |
Other names 1
- Sundance Rehabilitation Agency of Wisconsin
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041229000829 | WI | Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services | 7911815329 | Practice locations: Greenfield, WI; Kenosha, WI |
Outpatient physical therapy / speech pathology certification: CCN 526560
Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.
- Legal name
- SUNDANCE REHABILITATION AGENCY OF WISCONSIN
- Certification status
- Active
- Provider type (POS)
- Outpatient physical therapy / speech pathology
- Participating since
- Jul 21, 1995
- Last certification
- Jul 19, 2021
- Ownership / control type
- Proprietary
- Facility address
- 3933 S Prairie Hill Lane
Greenfield, WI 53228
Other NPIs with the same Medicare PAC ID 2
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
National Provider Directory
National Provider Directory- Tax ID family
- Sundance Rehab Corp
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- Rehabilitation Clinic/Center
- Deforest, WI
- NPI 1073912119
-
- Rehabilitation Clinic/Center
- Sewell, NJ
- NPI 1750336053
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148256000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1743638400000",
"number": "1841245701",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 E STATE ST",
"city": "KENNETT SQUARE",
"state": "PA",
"postal_code": "193483109",
"telephone_number": "610-925-4560",
"fax_number": "505-468-4681"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3933 S PRAIRIE HILL LN",
"address_2": "C/O HICKORY PARK",
"city": "GREENFIELD",
"state": "WI",
"postal_code": "532282371",
"telephone_number": "414-546-3371",
"fax_number": "847-360-9311"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SUNDANCE REHABILITATION LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-05-22",
"last_updated": "2025-04-03",
"certification_date": "2025-04-03",
"status": "A",
"authorized_official_last_name": "OPPEL",
"authorized_official_first_name": "IAN",
"authorized_official_title_or_position": "COO",
"authorized_official_telephone_number": "980-254-7007"
},
"taxonomies": [
{
"code": "261QR0400X",
"taxonomy_group": "",
"desc": "Clinic/Center, Rehabilitation",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "41811700",
"state": "WI"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Sundance Rehabilitation Agency of Wisconsin",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Sundance Rehabilitation Agency of Wisconsin",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Greenfield, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.