NPIMap

Organization Active NPI

Abg Wellness Group Inc

  • Community/Behavioral Health Agency
  • Milwaukee, WI
National Provider Identifier
1184087389
Registry record updated Apr 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
ABG WELLNESS GROUP INC
Practice address
11414 W Park PL Ste 202
Milwaukee, WI 53224-3500
Phone
(414) 292-7060
Fax
(414) 973-2090
NPI assigned
Apr 4, 2016
Last updated
Apr 4, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2016

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

Authorized official

Name
Alex Goldman, LPC, CSACNPI 1346413515
Title
Executive Director
Phone
(414) 292-7060

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X WI Primary

Addresses

Primary practice location

11414 W Park PL Ste 202
Milwaukee, WI 53224-3500

Mailing address

11414 W Park PL Ste 202
Milwaukee, WI 53224-3500
Phone (414) 292-7060

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160909002340 WI Part B Supplier - Clinic/Group Practice 0345536785 Receives reassigned benefits from 39 practitioners
Practice locations: Milwaukee, WI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 46

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.

View all 46

NPI Registry JSON

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

{
    "created_epoch": "1459728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459728000000",
    "number": "1184087389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11414 W PARK PL STE 202",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532243500",
            "telephone_number": "414-292-7060",
            "fax_number": "414-973-2090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11414 W PARK PL STE 202",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532243500",
            "telephone_number": "414-292-7060",
            "fax_number": "414-973-2090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABG WELLNESS GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-04",
        "last_updated": "2016-04-04",
        "status": "A",
        "authorized_official_last_name": "GOLDMAN",
        "authorized_official_first_name": "ALEX",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "414-292-7060",
        "authorized_official_credential": "LPC, CSAC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Apr 4, 2016; 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.