Individual provider Active NPI

Michael G Olenchek, P.T.

  • Physical Therapist
  • Oak Creek, WI
National Provider Identifier
1972897544
Registry record updated Nov 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
4567-024 Issued in WI
Practice address
200 E Ryan Rd
Oak Creek, WI 53154-4563
Phone
(414) 570-3590
NPI assigned
Jun 1, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 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 4567-024 WI Primary

Addresses

Primary practice location

200 E Ryan Rd
Oak Creek, WI 53154-4563

Mailing address

3301 W Forest Home Ave
Milwaukee, WI 53215-2843
Phone (414) 747-8400

Other practice location 1

2000 E Layton Ave
Suite 160
St Francis, WI 53235-6053
Phone (414) 747-8400

Other identifiers 1

IdentifierTypeStateIssuer
100070609MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/
Direct Messaging Address molenchek124548@direct.myadvocateaurora.org

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220112000406 WI Practitioner - Physical Therapist in Private Practice 1658763206 Reassigns benefits to 4 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
4567-024WIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Medical Group, Inc. CurrentSince Nov 18, 2021 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Nov 18, 2021 Accepting new patients
Aurora Health Care Metro, Inc. CurrentSince Nov 18, 2021 Accepting new patients
Aurora Health Care Metro, Inc. CurrentSince Nov 18, 2021 Accepting new patients
Lakeshore Medical Clinic, LLC Physical Therapist CurrentSince Nov 18, 2021 Accepting new patients
Aurora Advanced Healthcare Inc CurrentSince Nov 18, 2021 Accepting new patients
Aurora Medical Group, Inc. Current Accepting new patients
Lakeshore Medical Clinic LTD CurrentSince Nov 18, 2021 Accepting new patients
Aurora Advanced Healthcare, Inc. CurrentSince Nov 18, 2021 Accepting new patients

Locations

3003 W Good Hope Rd
Glendale, WI 53209
Phone (414) 352-3100

12203 N Corporate Pkwy
Mequon, WI 53092
Phone (262) 387-8200

2900 W Oklahoma Ave
Milwaukee, WI 53215
Phone (414) 385-2590

3301 W Forest Home Ave
Milwaukee, WI 53215
Phone (414) 389-2233

1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056

S74W16775 Janesville Rd
Muskego, WI 53150
Phone (414) 422-4747

200 E Ryan Rd
Oak Creek, WI 53154
Phone (414) 570-3590

2000 E Layton Ave
Ste 160
St Francis, WI 53235
Phone (414) 747-6020

2000 E Layton Ave
St Francis, WI 53235
Phone (414) 744-7880

Interoperability endpoints

  • Direct secure messaging: molenchek124548@direct.myadvocateaurora.org

Organizations & group practices 9

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": "1306886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731888000000",
    "number": "1972897544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3301 W FOREST HOME AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532152843",
            "telephone_number": "414-747-8400",
            "fax_number": "414-747-8414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 E RYAN RD",
            "city": "OAK CREEK",
            "state": "WI",
            "postal_code": "531544563",
            "telephone_number": "414-570-3590"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2000 E Layton Ave",
            "address_2": "Suite 160",
            "address_purpose": "LOCATION",
            "city": "St Francis",
            "state": "WI",
            "postal_code": "532356053",
            "country_code": "US",
            "telephone_number": "414-747-8400",
            "fax_number": "414-747-8414",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OLENCHEK",
        "first_name": "MICHAEL",
        "middle_name": "G",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-01",
        "last_updated": "2024-11-18",
        "certification_date": "2024-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "4567-024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100070609",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "200 E Ryan Rd",
            "city": "Oak Creek",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531544563",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "molenchek124548@direct.myadvocateaurora.org",
            "affiliation": "N",
            "address_1": "200 E Ryan Rd",
            "city": "Oak Creek",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531544563",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Oak Creek, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2024; 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.