Active NPI
Kim D Prusha, LPC
- Professional Counselor
- Menasha, WI
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 397
- Practice address
- 1095 Midway Rd
Menasha, WI 54952-1115 - Phone
- (920) 720-2300
- Fax
- (920) 720-3806
- NPI assigned
- Feb 2, 2011
- Last updated
- Dec 8, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 397 | WI | Primary |
Addresses
Primary practice location
1095 Midway Rd
Menasha, WI 54952-1115
Mailing address
3 Neenah Ctr
Neenah, WI 54956-3070
Phone (920) 720-2300
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: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Mental Health Counselor
- Education
- Other, 1990
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1095 Midway Rd
Menasha, WI 54952-1115
Phone (920) 720-2300
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Thedacare, Incorporated | Current | Accepting new patients | |
| Thedacare, Incorporated | Current | Accepting new patients |
Locations
1818 N Meade St
Appleton, WI 54911
Phone (920) 731-4101
1095 Midway Rd
Menasha, WI 54952
Phone (920) 720-3700
3 Neenah Ctr
Neenah, WI 54956
Phone (920) 454-4229
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.
-
dba ThedaCare Physicians
- Family Medicine Physician
- New London, WI
- NPI 1376656959
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1296604800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701993600000",
"number": "1114223542",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3 NEENAH CTR",
"city": "NEENAH",
"state": "WI",
"postal_code": "549563070",
"telephone_number": "920-720-2300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1095 MIDWAY RD",
"city": "MENASHA",
"state": "WI",
"postal_code": "549521115",
"telephone_number": "920-720-2300",
"fax_number": "920-720-3806"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRUSHA",
"first_name": "KIM",
"middle_name": "D",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-02-02",
"last_updated": "2023-12-08",
"certification_date": "2023-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "WI",
"license": "397",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Menasha, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.