NPIMap

Organization Active NPI

Waukesha County

  • Primary Care Clinic/Center
  • Waukesha, WI
National Provider Identifier
1346364585
Registry record updated Nov 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
41861400 Issued in WI
Legal business name
WAUKESHA COUNTY
Practice address
514 Riverview Ave
Waukesha, WI 53188-3632
Phone
(262) 896-8430
Fax
(262) 896-8387
NPI assigned
Mar 16, 2007
Last updated
Nov 10, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2025

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

Authorized official

Name
David M Derosier
Title
Credentialing Specialist
Phone
(262) 548-8431

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X 82059 WI
Public Health or Welfare Agency 251K00000X 000082059 WI
Primary Care Clinic/Center 261QP2300X 41861400 WI Primary

Addresses

Primary practice location

514 Riverview Ave
Waukesha, WI 53188-3632

Mailing address

514 Riverview Ave
Attn: Fiscal Department
Waukesha, WI 53188-3632
Phone (262) 548-7212

Other identifiers 2

IdentifierTypeStateIssuer
41861400MedicaidWI
000082059OtherWIMEDICARE LEGACY

Other names 1

  • Waukesha County (Public Health) Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080611000016 WI Part B Supplier - Mass Immunization (Roster Biller Only) 3971405481 Practice locations: Waukesha, WI

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Waukesha County HLTH de13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Locations

514 Riverview Ave
Waukesha, WI 53188
Phone (262) 548-7212

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Waukesha CountyWaukesha, WI, CCN 524026 Hospital Operational/Managerial Control Jan 20, 2011

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 2

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": "1174003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762732800000",
    "number": "1346364585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "514 RIVERVIEW AVE",
            "address_2": "ATTN: FISCAL DEPARTMENT",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531883632",
            "telephone_number": "262-548-7212",
            "fax_number": "262-970-6696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "514 RIVERVIEW AVE",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531883632",
            "telephone_number": "262-896-8430",
            "fax_number": "262-896-8387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAUKESHA COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-16",
        "last_updated": "2025-11-10",
        "certification_date": "2025-11-10",
        "status": "A",
        "authorized_official_last_name": "DEROSIER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "262-548-8431"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "WI",
            "license": "82059",
            "primary": false
        },
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": "WI",
            "license": "000082059",
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "WI",
            "license": "41861400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41861400",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE LEGACY",
            "identifier": "000082059",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Waukesha County (Public Health)",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Waukesha County (Public Health)",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Waukesha, WI

Sources for this page

Verify at the official NPI Registry.