Active NPI
Edward Gabriel Immekus, PT
- Physical Therapist
- Sun Prairie, WI
National Provider Identifier
1992977185
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 10962-024
- Practice address
- 10 Tower Dr
Sun Prairie, WI 53590-1239 - Phone
- (608) 825-3500
- Fax
- (608) 825-3598
- NPI assigned
- Mar 27, 2008
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 10962-024 | WI | Primary |
Addresses
Primary practice location
10 Tower Dr
Sun Prairie, WI 53590-1239
Mailing address
1808 W Beltline Hwy
Madison, WI 53713-2334
Phone (608) 250-1497
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | eimmekus261530@direct-ehr-ssmhc.com | Direct | |
| FHIR URL | https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ | Other |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10962-024 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1206576000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1615680000000",
"number": "1992977185",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1808 W BELTLINE HWY",
"city": "MADISON",
"state": "WI",
"postal_code": "537132334",
"telephone_number": "608-250-1497",
"fax_number": "608-250-1384"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 TOWER DR",
"city": "SUN PRAIRIE",
"state": "WI",
"postal_code": "535901239",
"telephone_number": "608-825-3500",
"fax_number": "608-825-3598"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IMMEKUS",
"first_name": "EDWARD",
"middle_name": "GABRIEL",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-03-27",
"last_updated": "2021-03-14",
"certification_date": "2021-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "10962-024",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "eimmekus261530@direct-ehr-ssmhc.com",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "eimmekus261530@direct-ehr-ssmhc.com",
"address_1": "10 Tower Dr",
"city": "Sun Prairie",
"state": "WI",
"country_code": "US",
"postal_code": "535901239",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "FHIR",
"endpointTypeDescription": "FHIR URL",
"endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
"affiliation": "N",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "FHIR API",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "CCD",
"address_1": "10 Tower Dr",
"city": "Sun Prairie",
"state": "WI",
"country_code": "US",
"postal_code": "535901239",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Sun Prairie, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.