Organization Active NPI

Allen Family Medicine SC

  • Family Medicine Physician
  • Cudahy, WI
National Provider Identifier
1073407433
Registry record updated Jun 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
ALLEN FAMILY MEDICINE SC
Practice address
4580 S Nicholson Ave
Cudahy, WI 53110-1360
Phone
(414) 326-4800
Fax
(855) 270-4751
NPI assigned
Jun 9, 2025
Last updated
Jun 9, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Timothy William Allen, MDNPI 1720007271
Title
President
Phone
(414) 326-4800

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary
Addiction Medicine (Family Medicine) Physician 207QA0401X NU

Addresses

Primary practice location

4580 S Nicholson Ave
Cudahy, WI 53110-1360

Mailing address

4580 S Nicholson Ave
Cudahy, WI 53110-1360
Phone (414) 326-4800

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250708003643 WI Part B Supplier - Clinic/Group Practice 5799299194 Receives reassigned benefits from 2 practitioners
Practice locations: Cudahy, WI

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
52D2171660Allen Family Medicine4580 S Nicholson Ave, Cudahy, WI 53110Provider-performed microscopyMar 6, 2028

National Provider Directory

National Provider Directory

Locations

4580 S Nicholson Ave
Cudahy, WI 53110
Phone (414) 326-4800

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1749427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749427200000",
    "number": "1073407433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4580 S NICHOLSON AVE",
            "city": "CUDAHY",
            "state": "WI",
            "postal_code": "531101360",
            "telephone_number": "414-326-4800",
            "fax_number": "855-270-4751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4580 S NICHOLSON AVE",
            "city": "CUDAHY",
            "state": "WI",
            "postal_code": "531101360",
            "telephone_number": "414-326-4800",
            "fax_number": "855-270-4751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLEN FAMILY MEDICINE SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-06-09",
        "last_updated": "2025-06-09",
        "certification_date": "2025-06-08",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "414-326-4800",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cudahy, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.