Individual provider Active NPI

Craig A Groskreutz, MS, LPC

  • Psychologist
  • West Bend, WI
National Provider Identifier
1376015701
Registry record updated Sep 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
5429-57 Issued in WI
Practice address
111 E Washington St
West Bend, WI 53095-2571
Phone
(262) 338-2717
Fax
(262) 338-9767
NPI assigned
Dec 25, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 9, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 7205-125 WI
Psychologist 103T00000X 5429-57 WI Primary

Addresses

Primary practice location

111 E Washington St
West Bend, WI 53095-2571

Mailing address

104A Fence Line Ave
Iron Ridge, WI 53035
Phone (608) 317-5544

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20231227003048 WI Practitioner - Mental Health Counselor 5890145296 Reassigns benefits to 1 organization
I20251226000694 WI Practitioner - Clinical Psychologist 5890145296 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Affiliated Clinical Services IncGroup PAC ID 0244124899, 22 clinicians

Practice addresses (Care Compare)

111 E Washington St
West Bend, WI 53095-2571
Phone (262) 338-2717

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
5429-57WIMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Affiliated Clinical Services Inc CurrentSince Jan 1, 2024 Accepting new patients

Locations

111 E Washington St
West Bend, WI 53095
Phone (262) 338-2717

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": "1545696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757376000000",
    "number": "1376015701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104A FENCE LINE AVE",
            "city": "IRON RIDGE",
            "state": "WI",
            "postal_code": "53035",
            "telephone_number": "608-317-5544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 E WASHINGTON ST",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530952571",
            "telephone_number": "262-338-2717",
            "fax_number": "262-338-9767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GROSKREUTZ",
        "first_name": "CRAIG",
        "middle_name": "A",
        "credential": "MS, LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-12-25",
        "last_updated": "2025-09-09",
        "certification_date": "2025-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "7205-125",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WI",
            "license": "5429-57",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Bend, WI

Sources for this page

Verify at the official NPI Registry.