Individual provider Active NPI

Tammy Johnsen, NP

  • Nurse Practitioner
  • Waukesha, WI
National Provider Identifier
1073713913
Registry record updated Aug 22, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
7504 Issued in WI
Practice address
721 American Ave Ste 403
Waukesha, WI 53188-5071
Phone
(262) 549-1516
Fax
(262) 549-0648
NPI assigned
Jul 19, 2007
Last updated
Aug 22, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 209005063 IL
Nurse Practitioner 363L00000X 7504 WI Primary

Addresses

Primary practice location

721 American Ave Ste 403
Waukesha, WI 53188-5071

Mailing address

1860 Paysphere Cir
Chicago, IL 60674-0018

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170607001164 WI Practitioner - Nurse Practitioner 1759477821 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Prohealth Medical Group IncGroup PAC ID 3476465188, 475 clinicians

Practice addresses (Care Compare)

1185 Corporate Ctr Dr
Suite 175
Oconomowoc, WI 53066-4889
Phone (262) 928-8400

725 American Ave
Waukesha, WI 53188-5031
Phone (262) 928-1000

791 Summit Ave
Oconomowoc, WI 53066-3844
Phone (262) 569-0554

N17W24100 Riverwood Dr
Waukesha, WI 53188-1127
Phone (262) 928-4704

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
7504WIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Prohealth Medical Group Inc. CurrentSince Jun 19, 2017 Accepting new patients
Prohealth Medical Group Inc Past Accepting new patients

Locations

195 Discovery Dr
Brookfield, WI 53045
Phone (262) 513-7100

2750 Golf Rd
Delafield, WI 53018
Phone (262) 928-4900

1500 Walnut Ridge Dr
Hartland, WI 53029
Phone (262) 513-7500

240 Maple Ave
Mukwonago, WI 53149
Phone (262) 928-1900

S69W15636 Janesville Rd
Muskego, WI 53150
Phone (262) 513-7000

13900 W National Ave
New Berlin, WI 53151
Phone (262) 928-4500

1185 Corporate Center Dr
Ste 175
Oconomowoc, WI 53066
Phone (262) 928-6236

791 Summit Ave
Summit, WI 53066
Phone (262) 569-0251

N57W24950 N Corporate Cir
Sussex, WI 53089
Phone (262) 820-3093

109 Air Park Dr
Watertown, WI 53094
Phone (262) 928-5100

2130 Big Bend Rd
Waukesha, WI 53189
Phone (262) 513-7555

717 W Moreland Blvd
Waukesha, WI 53188
Phone (262) 542-9100

721 American Ave
Ste 403
Waukesha, WI 53188
Phone (262) 549-1516

725 American Ave
Waukesha, WI 53188
Phone (262) 544-2011

N14W23900 Stone Ridge Dr
Waukesha, WI 53188
Phone (262) 549-3030

N16W24131 Riverwood Dr
Waukesha, WI 53188
Phone (262) 696-0696

N17W24100 Riverwood Dr
Waukesha, WI 53188
Phone (262) 820-3093

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1184803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1503360000000",
    "number": "1073713913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1860 PAYSPHERE CIR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606740018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "721 AMERICAN AVE STE 403",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531885071",
            "telephone_number": "262-549-1516",
            "fax_number": "262-549-0648"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSEN",
        "first_name": "TAMMY",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-19",
        "last_updated": "2017-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209005063",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "7504",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waukesha, WI

Sources for this page

Verify at the official NPI Registry.