Annaliese Marie Koller Shumate, D.O.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

60433-21 Issued in WI

Practice address

1155 N Mayfair Rd
3Rd Floor, Department of Psychiatry
Wauwatosa, WI 53226-3462

Phone

(414) 955-8990

NPI assigned

Apr 7, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

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

• County of Milwaukee

  • Psychologist
  • Milwaukee, WI
  • NPI 1942362066
  Medicare reassignment

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

{
    "created_epoch": "1302134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1381968000000",
    "number": "1174812499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1155 N MAYFAIR RD",
            "address_2": "3RD FLOOR, DEPARTMENT OF PSYCHIATRY",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532263462",
            "telephone_number": "414-955-8990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1155 N MAYFAIR RD",
            "address_2": "3RD FLOOR, DEPARTMENT OF PSYCHIATRY",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532263462",
            "telephone_number": "414-955-8990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLLER SHUMATE",
        "first_name": "ANNALIESE",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-07",
        "last_updated": "2013-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "WI",
            "license": "60433-21",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mellisa Yu Koenings, PA-C
• Jamie Nicole Koepke
• Katie A Koester, MPT
• Paul Koester, LPC, CSAC
• Stephanie L Kohler-Neuwirth
• Mikaela J Koller
• Meghan Konda, MD
• Alexis Kopecky
• Hannah Koraly, LAT, ATC
• David B Kornreich, DO

• General Practice Physician in Wauwatosa, WI
• Providers in Wauwatosa, WI by specialty
• General Practice Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2013; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.