NPIMap

Organization Active NPI

Waukesha Health System, Inc

  • Community/Retail Pharmacy
  • Waukesha, WI
National Provider Identifier
1073528675
Registry record updated Dec 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
669442 Issued in WI
Legal business name
WAUKESHA HEALTH SYSTEM, INC
Practice address
725 American Ave Ste 2309
Waukesha, WI 53188-5031
Phone
(262) 928-2279
Fax
(262) 544-0928
NPI assigned
Jul 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2022

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

Authorized official

Name
Thomas W Johnson
Title
Reimbursement Manager
Phone
(262) 928-4704

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 669442 WI Primary

Addresses

Primary practice location

725 American Ave Ste 2309
Waukesha, WI 53188-5031

Mailing address

725 American Ave
Waukesha, WI 53188-5031
Phone (262) 928-2279

Other identifiers 2

IdentifierTypeStateIssuer
2113659OtherPK
33154500MedicaidWI

Other names 1

  • ProHealth Pharmacy - Waukesha Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040422001085 WI Part B Supplier - Clinic/Group Practice 4082519517 Receives reassigned benefits from 1 practitioner
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Mukwonago, WI; Waukesha, WI

National Provider Directory

National Provider Directory
Tax ID family
Blair Center7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

512 Wilcox St
#2
Fort Atkinson, WI 53538
Phone (920) 568-1810

520 Handeyside Ln
Ste 5
Fort Atkinson, WI 53538
Phone (920) 568-0673

240 Maple Ave
Ste 1420
Mukwonago, WI 53149
Phone (262) 363-1900

725 American Ave
Ste 2309
Waukesha, WI 53188
Phone (262) 928-2279

3011 Saylesville Rd
Waukesha, WI 53189
Phone (262) 928-6900

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670976000000",
    "number": "1073528675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 AMERICAN AVE",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531885031",
            "telephone_number": "262-928-2279",
            "fax_number": "262-544-0928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 AMERICAN AVE STE 2309",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531885031",
            "telephone_number": "262-928-2279",
            "fax_number": "262-544-0928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAUKESHA HEALTH SYSTEM, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-30",
        "last_updated": "2022-12-14",
        "certification_date": "2022-12-14",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "REIMBURSEMENT MANAGER",
        "authorized_official_telephone_number": "262-928-4704"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WI",
            "license": "669442",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2113659",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33154500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ProHealth Pharmacy - Waukesha",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ProHealth Pharmacy - Waukesha",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waukesha, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2022; 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.