Individual provider Active NPI

Prabhas Mittal, MD

  • Hematology & Oncology Physician
  • Milwaukee, WI
National Provider Identifier
1366476319
Registry record updated Oct 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
50320 Issued in WI
Practice address
9200 W Wisconsin Ave
Neoplastic Diseases
Milwaukee, WI 53226-3522
Phone
(414) 805-6800
Fax
(414) 805-0618
NPI assigned
Jul 10, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Oncology Physician 207RX0202X MD00041314 WA
Hematology & Oncology Physician 207RH0003X 50320 WI Primary

Addresses

Primary practice location

9200 W Wisconsin Ave
Neoplastic Diseases
Milwaukee, WI 53226-3522

Mailing address

9200 W Wisconsin Ave
Neoplastic Diseases
Milwaukee, WI 53226-3522
Phone (414) 805-6800

Other identifiers 3

IdentifierTypeStateIssuer
0164822OtherWAL&I
1366476319MedicaidWI
8331225MedicaidWA

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
I20071214000706 WI Practitioner - Hematology/OncologyPractitioner - Internal Medicine 3870683758 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
87.99 of 100Reported as group
Quality
82.81
Promoting interoperability
100
Improvement activities
40
Cost
77.15

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
50320WIMDHematology & Oncology Physician
MD00041314WAMDMedical Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Medical College of Wisconsin, Inc. CurrentSince Aug 14, 2017 Accepting new patients

Locations

10911 N Port Washington Rd
Mequon, WI 53092
Phone (262) 241-2080

1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056

Bin 88350
Milwaukee, WI 53288
Phone (414) 805-3122

840 N 87th St
Wauwatosa, WI 53226
Phone (414) 805-5540

8701 Watertown Plank Rd
Wauwatosa, WI 53226
Phone (414) 456-4100

9200 W Wisconsin Ave
Wauwatosa, WI 53226
Phone (414) 259-3000

8901 W Lincoln Ave
West Allis, WI 53227
Phone (414) 328-6000

Interoperability endpoints

  • Direct secure messaging: pmittalmd39858@direct.froedtert.com

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601510400000",
    "number": "1366476319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9200 W WISCONSIN AVE",
            "address_2": "NEOPLASTIC DISEASES",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532263522",
            "telephone_number": "414-805-6800",
            "fax_number": "414-805-0618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9200 W WISCONSIN AVE",
            "address_2": "NEOPLASTIC DISEASES",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532263522",
            "telephone_number": "414-805-6800",
            "fax_number": "414-805-0618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITTAL",
        "first_name": "PRABHAS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-10",
        "last_updated": "2020-10-01",
        "certification_date": "2020-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RX0202X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Medical Oncology",
            "state": "WA",
            "license": "MD00041314",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "WI",
            "license": "50320",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I",
            "identifier": "0164822",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1366476319",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8331225",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.