Individual provider Active NPI

Brandon John Bigelow, PT

  • Physical Therapist
  • Pewaukee, WI
National Provider Identifier
1861186967
Registry record updated Sep 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
16387-24 Issued in WI
Practice address
2835 N Grandview Blvd Ste 100
Pewaukee, WI 53072-5546
Phone
(262) 574-1100
Fax
(262) 574-5193
NPI assigned
Jun 5, 2023
Last updated
Sep 29, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 16387-24 WI Primary

Addresses

Primary practice location

2835 N Grandview Blvd Ste 100
Pewaukee, WI 53072-5546

Mailing address

790 Remington Blvd
Bolingbrook, IL 60440-4909

Other practice location 1

8619 S Howell Ave
Oak Creek, WI 53154-2919
Phone (262) 671-2033

Other practice location 2

N15W28300 Golf Rd
Pewaukee, WI 53072-4800
Phone (262) 303-5055

Other identifiers 1

IdentifierTypeStateIssuer
100247450MedicaidWI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230828000293 WI Practitioner - Physical Therapist in Private Practice 7618330416 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2023
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

N15W28300 Golf Rd
Pewaukee, WI 53072

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Midwest Orthopedic Specialty Hospital, LLC Current Accepting new patients
Athletic & Therapeutic Institute of Milwaukee, LLC Physical Therapist CurrentSince Oct 25, 2024 Accepting new patients
Midwest Orthopedic Specialty Hospital, LLC CurrentSince Jul 15, 2023 Accepting new patients
Athletic & Therapeutic Institute of Milwaukee, LLC Physical Therapist CurrentSince Oct 25, 2024 Accepting new patients
Athletic & Therapeutic Institute of Milwaukee, LLC Physical Therapist Current Accepting new patients
Midwest Orthopedic Specialty Hospital, LLC CurrentSince Jul 15, 2023 Accepting new patients

Locations

790 Remington Blvd
Bolingbrook, IL 60440

7095 S Ballpark Dr
Unit 100
Franklin, WI 53132
Phone (414) 817-6620

S74W16867 Janesville Rd
Muskego, WI 53150
Phone (262) 971-4200

8201 S Howell Ave
Ste 400
Oak Creek, WI 53154
Phone (414) 295-9045

2835 N Grandview Blvd
Ste 100
Pewaukee, WI 53072
Phone (262) 574-1100

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1685923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727568000000",
    "number": "1861186967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2835 N GRANDVIEW BLVD STE 100",
            "city": "PEWAUKEE",
            "state": "WI",
            "postal_code": "530725546",
            "telephone_number": "262-574-1100",
            "fax_number": "262-574-5193"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8619 S Howell Ave",
            "address_purpose": "LOCATION",
            "city": "Oak Creek",
            "state": "WI",
            "postal_code": "531542919",
            "country_code": "US",
            "telephone_number": "262-671-2033",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "N15W28300 Golf Rd",
            "address_purpose": "LOCATION",
            "city": "Pewaukee",
            "state": "WI",
            "postal_code": "530724800",
            "country_code": "US",
            "telephone_number": "262-303-5055",
            "fax_number": "262-303-5057",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BIGELOW",
        "first_name": "BRANDON",
        "middle_name": "JOHN",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-05",
        "last_updated": "2024-09-29",
        "certification_date": "2024-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "16387-24",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100247450",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pewaukee, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2024; 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.