Active NPI
Renata B Ptak, PA-C
- Physician Assistant
- Glendale, WI
National Provider Identifier
1902955933
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 1779-023
- Practice address
- 2501 W Silver Spring Dr
Glendale, WI 53209-4217 - Phone
- (414) 461-9250
- Fax
- (414) 461-3553
- NPI assigned
- Jan 9, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1779-023 | WI | Primary |
Addresses
Primary practice location
2501 W Silver Spring Dr
Glendale, WI 53209-4217
Mailing address
2501 W Silver Spring Dr
Glendale, WI 53209-4217
Phone (414) 461-9250
Other names 1
- Renata B Ptak
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10202 | MN | MD | Clinical Social Worker |
| 1779-023 | WI | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Clare Memorial Hospital, Inc | Past | Accepting new patients | |
| Chisholm Medical Clinic | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Critical Access Hospital
- Oconto Falls, WI
- NPI 1851477913
-
- Family Medicine Physician
- Chisholm, MN
- NPI 1871507632
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1593475200000",
"number": "1902955933",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2501 W SILVER SPRING DR",
"city": "GLENDALE",
"state": "WI",
"postal_code": "532094217",
"telephone_number": "414-461-9250",
"fax_number": "414-461-3553"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2501 W SILVER SPRING DR",
"city": "GLENDALE",
"state": "WI",
"postal_code": "532094217",
"telephone_number": "414-461-9250",
"fax_number": "414-461-3553"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PTAK",
"first_name": "RENATA",
"middle_name": "B",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-09",
"last_updated": "2020-06-30",
"certification_date": "2020-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WI",
"license": "1779-023",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "RENATA",
"last_name": "PTAK",
"middle_name": "B",
"credential": "PHYSICIAN ASSISTANT",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Glendale, WI
- Prominent Healthcare LLC
- Prominent Home Care (Homewatch CareGivers)
- Providence Family Medical Clinic S.C
- Providence Family Pharmacy LLC
- Providence Pharmacy & Wellness
- Joseph Puccinelli, M.D.
- Elishia L. Pulliam, MS, LPC
- Mary A. Quinn, DDS
- R.E.a.C.H. Inc. Comprehensive Mental Health Clinic
- RDC Pharmacy LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.