Active NPI
Wayne W Harder, PHD
- Psychologist
- Milwaukee, WI
National Provider Identifier
1225053945
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 1191057
- Practice address
- 11803 W North Avenue
Milwaukee, WI 53226 - Phone
- (414) 259-0205
- NPI assigned
- Jul 13, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 1191057 | WI | Primary |
Addresses
Primary practice location
11803 W North Avenue
Milwaukee, WI 53226
Mailing address
1001 W Glen Oaks LN
Ste 105
Mequon, WI 53092-3365
Phone (414) 365-3210
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39043000 | Medicaid | WI |
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
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110218000159 | WI | Practitioner - Clinical Psychologist | 8123209566 | Practice locations: Milwaukee, WI |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1985
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
11803 W N Ave
Suite 208
Milwaukee, WI 53226-2077
Phone (414) 259-0205
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1191057 | WI | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152748800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1452470400000",
"number": "1225053945",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1001 W GLEN OAKS LN",
"address_2": "STE 105",
"city": "MEQUON",
"state": "WI",
"postal_code": "530923365",
"telephone_number": "414-365-3210",
"fax_number": "414-365-2937"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11803 W NORTH AVENUE",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "53226",
"telephone_number": "414-259-0205"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARDER",
"first_name": "WAYNE",
"middle_name": "W",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-13",
"last_updated": "2016-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "WI",
"license": "1191057",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "39043000",
"state": "WI"
}
],
"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 Jan 11, 2016; 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.