NPIMap

Organization Active NPI

Prohealth Medical Group Inc

  • Internal Medicine Physician
  • Muskego, WI
National Provider Identifier
1114068970
Registry record updated May 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
PROHEALTH MEDICAL GROUP INC
Practice address
S69W15636 Janesville Rd
Muskego, WI 53150-9330
Phone
(262) 928-7000
Fax
(414) 422-2075
NPI assigned
Feb 12, 2007
Last updated
May 23, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
PROHEALTH MEDICAL GROUP INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 23, 2022

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

Authorized official

Name
Peter Geiss, MD
Title
President
Phone
(262) 928-8669

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU
Internal Medicine Physician 207R00000X NU Primary
Cardiovascular Disease Physician 207RC0000X NU
Pediatrics Physician 208000000X NU

Addresses

Primary practice location

S69W15636 Janesville Rd
Muskego, WI 53150-9330

Mailing address

N17W24100 Riverwood Dr
Suite 250
Waukesha, WI 53188-1177
Phone (262) 928-4100

Other identifiers 2

IdentifierTypeStateIssuer
32819000MedicaidWI
0505180004OtherWIDME

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031103000066 WI Part B Supplier - Clinic/Group Practice 3476465188 Receives reassigned benefits from 570 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 14

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

View all 14

National Provider Directory

National Provider Directory
Part of
Prohealth Medical Group Inc

NPI Registry JSON

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653264000000",
    "number": "1114068970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N17W24100 RIVERWOOD DR",
            "address_2": "SUITE 250",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531881177",
            "telephone_number": "262-928-4100",
            "fax_number": "262-928-5835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "S69W15636 JANESVILLE RD",
            "city": "MUSKEGO",
            "state": "WI",
            "postal_code": "531509330",
            "telephone_number": "262-928-7000",
            "fax_number": "414-422-2075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROHEALTH MEDICAL GROUP INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROHEALTH MEDICAL GROUP INC",
        "enumeration_date": "2007-02-12",
        "last_updated": "2022-05-23",
        "certification_date": "2022-05-23",
        "status": "A",
        "authorized_official_last_name": "GEISS, MD",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "262-928-8669"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32819000",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DME",
            "identifier": "0505180004",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Muskego, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 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.