NPIMap

Organization Active NPI

Archwell Health Professional Services of Wisconsin, SC

Doing business as ArchWell Health

  • Internal Medicine Physician
  • Milwaukee, WI
National Provider Identifier
1164228797
Registry record updated Feb 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
ARCHWELL HEALTH PROFESSIONAL SERVICES OF WISCONSIN, SC
Doing business as
ArchWell Health
Practice address
2730 N Martin Luther King Dr
Milwaukee, WI 53212-2312
Phone
(414) 508-0002
NPI assigned
Feb 24, 2025
Last updated
Feb 3, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2026

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

Authorized official

Name
Amy Moddesette
Title
Sr. Director, Managed Care Ops
Phone
(913) 226-8221

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X NU
Family Medicine Physician 207Q00000X NU
Internal Medicine Physician 207R00000X NU Primary
Cardiovascular Disease Physician 207RC0000X NU

Addresses

Primary practice location

2730 N Martin Luther King Dr
Milwaukee, WI 53212-2312

Mailing address

102 Woodmont Blvd Ste 600
Nashville, TN 37205-5250
Phone (888) 987-1151

Other names 1

  • ArchWell Health Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260309000092 WI Part B Supplier - Clinic/Group Practice 0648752634 Receives reassigned benefits from 10 practitioners
Practice locations: West Allis, WI; Milwaukee, 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
52D2338407Archwell Health Professional Services of Wisconsin2730 N Martin Luther King Dr, Milwaukee, WI 53212Certificate of waiverFeb 9, 2028

National Provider Directory

National Provider Directory

Locations

1010 W Layton Ave
Milwaukee, WI 53221

1016 W Layton Ave
Milwaukee, WI 53221
Phone (414) 508-2363

2730 N Martin Luther King Dr
Milwaukee, WI 53212
Phone (414) 508-0002

7450 W Oklahoma Ave
Milwaukee, WI 53219

7540 W Oklahoma Ave
Milwaukee, WI 53219

Practitioners & affiliated clinicians

Practitioners 12

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": "1740355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770076800000",
    "number": "1164228797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 WOODMONT BLVD STE 600",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372055250",
            "telephone_number": "888-987-1151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2730 N MARTIN LUTHER KING DR",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532122312",
            "telephone_number": "414-508-0002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARCHWELL HEALTH PROFESSIONAL SERVICES OF WISCONSIN, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-24",
        "last_updated": "2026-02-03",
        "certification_date": "2026-02-03",
        "status": "A",
        "authorized_official_last_name": "MODDESETTE",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "SR. DIRECTOR, MANAGED CARE OPS",
        "authorized_official_telephone_number": "913-226-8221"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "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
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ArchWell Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Milwaukee, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2026; 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.