Laura Nissen, is a medicare enrolled "Physical Therapist" provider in Kimberly, Wisconsin. Her current practice location is
825 Cobblestone Ln, Kimberly, Wisconsin. You can reach out to her office (for appointments etc.) via phone at
(920) 282-6658.
Laura Nissen is licensed to practice in Wisconsin (license number 5793-024) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1942082029.
Healthcare Provider's Profile
| Full Name | Laura Nissen |
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| Gender | Female |
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| Speciality | Physical Therapist |
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| Location | 825 Cobblestone Ln, Kimberly, Wisconsin |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1942082029
- Provider Enumeration Date: 10/16/2023
- Last Update Date: 10/16/2023
Medicare PECOS Information:
- PECOS PAC ID: 4486003449
- Enrollment ID: I20231215001517
Medical Identifiers
Medical identifiers for Laura Nissen such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1942082029 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 225100000X | Physical Therapist | 5793-024 (Wisconsin) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Laura Nissen allows following entities to bill medicare on her behalf.
| Provider Name | Aegis Group Practice Llc |
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| Provider Type | Part B Supplier - Clinic/group Practice |
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| Provider Identifiers | NPI Number: 1275073363
PECOS PAC ID: 5193036432
Enrollment ID: O20170614002978 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Laura Nissen is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Laura Nissen,
2904 E Corridor Dr,
Appleton, WI 54913-6722
Ph: (920) 915-9675 | Laura Nissen,
825 Cobblestone Ln,
Kimberly, WI 54136-2116
Ph: (920) 282-6658 |
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