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Prohealth Medical Group Inc

Organization Active NPI Family Medicine Physician · Hartland, WI

NPI 1386785178 · NPPES record last updated May 23, 2022

Key facts

NPI
1386785178
Entity type
Organization (NPI type 2)
Primary specialty
Family Medicine Physician 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
Organization subpart
Yes
Parent organization (as reported)
PROHEALTH MEDICAL GROUP INC

Authorized official

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

Other NPIs on the same Medicare enrollment 14

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

Other NPIs with the same Medicare PAC ID 11

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

Corporate family (same tax ID) 12

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

Practitioners 491

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 491

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
52D0388385Prohealth Medical Group, Inc - Hartland
1500 Walnut Ridge Dr, Hartland, WI 53029		Certificate of waiverNov 4, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in WI

Medicare enrollment records

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

National Provider Directory

Tax ID family
Med Assoc Men Falls LTD (13 organizations share this tax ID)
Part of
Med Assoc Men Falls LTD

Locations

808 Cornerstone Ct
Waterford, WI 53185
Phone (262) 928-1977

N16W24131 Riverwood Dr
Waukesha, WI 53188
Phone (262) 696-0696

721 American Ave
Ste 501
Waukesha, WI 53188
Phone (262) 928-2396

N14W23800 Stone Ridge Dr
Ste 110
Waukesha, WI 53188
Phone (262) 696-5325

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X Yes
Internal Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 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

IdentifierTypeStateIssuer
0505180017OtherWIDME
32819100MedicaidWI

Other providers in Hartland, WI

All providers in Hartland, WI · Family Medicine Physician in Wisconsin

Sources for this page

Verify at the official NPI Registry.