Individual provider Active NPI

Kevin Wippermann

  • Physical Therapist
  • Beaver Dam, WI
National Provider Identifier
1962852673
Registry record updated Jun 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
12534-24 Issued in WI
Practice address
707 S University Ave
Beaver Dam, WI 53916-3027
Phone
(920) 887-4039
Fax
(920) 887-5970
NPI assigned
Jun 14, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2016

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 12534-24 WI Primary

Addresses

Primary practice location

707 S University Ave
Beaver Dam, WI 53916-3027

Mailing address

707 S University Ave
Beaver Dam, WI 53916-3027
Phone (920) 887-4039

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230207000956 WI Practitioner - Physical Therapist in Private Practice 1052783784 Reassigns benefits to 6 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
MCHS Hospitals Inc CurrentSince Oct 26, 2022 Accepting new patients
Lakeview Medical Center Inc of Rice Lake CurrentSince Oct 26, 2022 Accepting new patients
MCHS Hospitals Inc Current Accepting new patients
Beaver Dam Community Hospitals Inc CurrentSince Oct 26, 2022 Accepting new patients
Beaver Dam Community Hospitals Inc CurrentSince Oct 26, 2022 Accepting new patients
Memorial Hospital Inc CurrentSince Oct 26, 2022 Accepting new patients
Memorial Hospital Inc CurrentSince Oct 26, 2022 Accepting new patients
Flambeau Hospital Inc Current Accepting new patients
Flambeau Hospital Inc CurrentSince Oct 26, 2022 Accepting new patients
MCHS Hospitals Inc CurrentSince Oct 26, 2022 Accepting new patients
Marshfield Clinic Inc CurrentSince Oct 26, 2022 Accepting new patients
Lakeview Medical Center Inc of Rice Lake CurrentSince Oct 26, 2022 Accepting new patients

Locations

705 S University Ave
Beaver Dam, WI 53916
Phone (920) 885-6090

707 S University Ave
Beaver Dam, WI 53916
Phone (920) 887-4006

3501 Golf Rd
Eau Claire, WI 54701
Phone (715) 858-4200

1000 N Oak Ave
Marshfield, WI 54449
Phone (715) 387-5111

1102 S Center Ave
Merrill, WI 54452
Phone (715) 536-3399

N3708 River Ave
Neillsville, WI 54456
Phone (715) 743-3101

1700 W Stout St
Rice Lake, WI 54868
Phone (715) 236-6133

Organizations & group practices 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1465862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465862400000",
    "number": "1962852673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 S UNIVERSITY AVE",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539163027",
            "telephone_number": "920-887-4039",
            "fax_number": "920-887-5970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 S UNIVERSITY AVE",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539163027",
            "telephone_number": "920-887-4039",
            "fax_number": "920-887-5970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIPPERMANN",
        "first_name": "KEVIN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-14",
        "last_updated": "2016-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "12534-24",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaver Dam, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.