Ellen Grandaw Martin

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

4431-24 Issued in WI

Practice address

621 Spring CT
Random Lake, WI 53075-1790

Phone

(920) 960-0505

NPI assigned

Aug 23, 2021

Last updated

Aug 23, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

University of Wisconsin School of Medicine, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Aegis Group Practice LLCGroup PAC ID 5193036432, 399 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Aegis Group Practice LLC

  • Physical Therapist
  • Onalaska, WI
  • NPI 1306336565
  Medicare reassignment Care Compare group NPD
• Aegis Group Practice LLC

  • Physical Therapist
  • Elm Grove, WI
  • NPI 1003380205
  NPD
• Aegis Group Practice LLC

  • Physical Therapist
  • Indian Harbour Beach, FL
  • NPI 1932072030
  NPD

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

{
    "created_epoch": "1629676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629676800000",
    "number": "1902572571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 SPRING CT",
            "city": "RANDOM LAKE",
            "state": "WI",
            "postal_code": "530751790",
            "telephone_number": "920-960-0505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 SPRING CT",
            "city": "RANDOM LAKE",
            "state": "WI",
            "postal_code": "530751790",
            "telephone_number": "920-960-0505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "ELLEN",
        "middle_name": "GRANDAW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-08-23",
        "last_updated": "2021-08-23",
        "certification_date": "2021-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "4431-24",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle M Grace-Jensen, PT
• Megan C Horn, OTR
• Ideal Chiropractic
• Jensen Interhealth (PT Connections)
• Kathleen Mary Kohlbeck, OTR
• Mueller Therapy, Inc.
• Barbara Junge Mueller, OTR
• Carli V Mueller
• Richard Polk, PT
• Prohealth Chiropractic Center S.C.

• Physical Therapist in Random Lake, WI
• Providers in Random Lake, WI by specialty
• Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2021; 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.