NPIMap

Organization Active NPI

Prohealth Medical Group Inc

  • Family Medicine Physician
  • Hartland, WI
National Provider Identifier
1386785178
Registry record updated May 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PROHEALTH MEDICAL GROUP INC
Practice address
1500 Walnut Ridge Dr
Hartland, WI 53029-9317
Phone
(262) 928-7500
Fax
(262) 367-8744
NPI assigned
Feb 12, 2007
Last updated
May 23, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
PROHEALTH MEDICAL GROUP INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 23, 2022

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

Authorized official

Name
Peter Geiss, MD
Title
President
Phone
(262) 928-8669

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary
Internal Medicine Physician 207R00000X

Addresses

Primary practice location

1500 Walnut Ridge Dr
Hartland, WI 53029-9317

Mailing address

N17 W24100 Riverwood Dr
Suite 250
Waukesha, WI 53188-1131
Phone (262) 928-4100

Other identifiers 2

IdentifierTypeStateIssuer
0505180017OtherWIDME
32819100MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031103000066 WI Part B Supplier - Clinic/Group Practice 3476465188 Receives reassigned benefits from 570 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
O20111219000322 WI DME Supplier - Physician - General Practice 3476465188 Practice locations: Hartland, WI

Other NPIs with the same Medicare PAC ID 11

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

Other NPIs on the same Medicare enrollment 14

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 14

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
52D0388385Prohealth Medical Group, Inc - Hartland1500 Walnut Ridge Dr, Hartland, WI 53029Certificate of waiverNov 4, 2027

National Provider Directory

National Provider Directory
Tax ID family
Med Assoc Men Falls LTD13 organizations share this tax ID, including this one
Part of
Med Assoc Men Falls LTD

Other organizations with this tax ID 12

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

Locations

1500 Walnut Ridge Dr
Hartland, WI 53029
Phone (262) 513-7500

721 American Ave
Ste 508
Waukesha, WI 53188
Phone (262) 928-4898

N17W24100 Riverwood Dr
Ste 250
Waukesha, WI 53188

Practitioners & affiliated clinicians

Practitioners 83

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.

View all 83

NPI Registry JSON

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653264000000",
    "number": "1386785178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N17 W24100 RIVERWOOD DR",
            "address_2": "SUITE 250",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531881131",
            "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": "1500 WALNUT RIDGE DR",
            "city": "HARTLAND",
            "state": "WI",
            "postal_code": "530299317",
            "telephone_number": "262-928-7500",
            "fax_number": "262-367-8744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROHEALTH MEDICAL GROUP INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROHEALTH MEDICAL GROUP INC",
        "enumeration_date": "2007-02-12",
        "last_updated": "2022-05-23",
        "certification_date": "2022-05-23",
        "status": "A",
        "authorized_official_last_name": "GEISS, MD",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "262-928-8669"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DME",
            "identifier": "0505180017",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32819100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hartland, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.