Individual provider Active NPI

Daniel E. Johnson, M.D.

  • Family Medicine Physician
  • Mukwonago, WI
National Provider Identifier
1225001225
Registry record updated Nov 2, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
38023 Issued in WI
Practice address
240 Maple Ave
Prohealth Care Medical Associates, Inc.
Mukwonago, WI 53149-8475
Phone
(262) 928-1900
Fax
(262) 363-1949
NPI assigned
Feb 9, 2006
Last updated
Nov 2, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 38023 WI Primary

Addresses

Primary practice location

240 Maple Ave
Prohealth Care Medical Associates, Inc.
Mukwonago, WI 53149-8475

Mailing address

N17W24100 Riverwood Dr
Prohealth Care Medical Associates, Inc.
Waukesha, WI 53188-1177
Phone (262) 928-4100

Other identifiers 1

IdentifierTypeStateIssuer
32402000MedicaidWI

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: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100315000986 WI Practitioner - Family Practice 9234034380 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Iowa, RJ & L Carver College of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Prohealth Medical Group IncGroup PAC ID 3476465188, 475 clinicians

Practice addresses (Care Compare)

1185 Corporate Ctr Dr
Suite 175
Oconomowoc, WI 53066-4889
Phone (262) 928-8400

18905 W Capitol Dr
Suite 110
Brookfield, WI 53045-2752
Phone (866) 432-7855

240 Maple Ave
Mukwonago, WI 53149-8475
Phone (262) 928-1900

N16W24131 Riverwood Dr
Waukesha, WI 53188-1106
Phone (262) 696-0808

N17W24100 Riverwood Dr
Waukesha, WI 53188-1127
Phone (262) 928-4704

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions23
Removal or shaving of skin growth11

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
38023WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prohealth Medical Group Inc. Family Medicine CurrentSince Aug 7, 2011 Accepting new patients
Prohealth Medical Group Inc Family Medicine CurrentSince Aug 7, 2011 Accepting new patients
Prohealth Medical Group Inc Family Medicine Past Accepting new patients

Locations

W180N8085 Town Hall Rd
Menomonee Fls, WI 53051
Phone (262) 257-5000

240 Maple Ave
Mukwonago, WI 53149
Phone (262) 928-1900

400 Bay View Rd
Mukwonago, WI 53149
Phone (262) 363-1900

N14W23900 Stone Ridge Dr
Waukesha, WI 53188
Phone (262) 549-3030

N17W24100 Riverwood Dr
Waukesha, WI 53188
Phone (262) 820-3093

Interoperability endpoints

  • Direct secure messaging: djohnson5047@direct.phci.org

Organizations & group practices 3

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1139443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320192000000",
    "number": "1225001225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N17W24100 RIVERWOOD DR",
            "address_2": "PROHEALTH CARE MEDICAL ASSOCIATES, INC.",
            "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": "240 MAPLE AVE",
            "address_2": "PROHEALTH CARE MEDICAL ASSOCIATES, INC.",
            "city": "MUKWONAGO",
            "state": "WI",
            "postal_code": "531498475",
            "telephone_number": "262-928-1900",
            "fax_number": "262-363-1949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "DANIEL",
        "middle_name": "E.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-09",
        "last_updated": "2011-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "38023",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32402000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mukwonago, WI

Sources for this page

Verify at the official NPI Registry.