Active NPI
Prohealth Medical Group Inc
- Family Medicine Physician
- Oconomowoc, WI
National Provider Identifier
1386897965
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- PROHEALTH MEDICAL GROUP INC
- Practice address
- 820 Summit Ave
Oconomowoc, WI 53066-3900 - Phone
- (262) 567-0223
- Fax
- (262) 567-6380
- NPI assigned
- Oct 28, 2008
- Organization subpart
- Yes
- Parent organization
- PROHEALTH MEDICAL GROUP INC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Peter T Geiss, MD
- Title
- President
- Phone
- (262) 928-8669
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | WI | Primary |
Addresses
Primary practice location
820 Summit Ave
Oconomowoc, WI 53066-3900
Mailing address
N17W24100 Riverwood Dr
Suite 150
Waukesha, WI 53188-1177
Phone (262) 928-4100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
Other NPIs on the same Medicare enrollment 14
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Internal Medicine Physician
- Oconomowoc, WI
- NPI 1417085895
O20031103000066
-
- Obstetrics & Gynecology Physician
- Oconomowoc, WI
- NPI 1518009257
O20031103000066
-
- Internal Medicine Physician
- Oconomowoc, WI
- NPI 1588706998
O20031103000066
-
- Internal Medicine Physician
- Watertown, WI
- NPI 1629119417
O20031103000066
-
- Cardiovascular Disease Physician
- Waukesha, WI
- NPI 1952695470
O20031103000066
National Provider Directory
National Provider Directory- Part of
- Med Assoc Men Falls LTD
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1225152000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1653264000000",
"number": "1386897965",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "N17W24100 RIVERWOOD DR",
"address_2": "SUITE 150",
"city": "WAUKESHA",
"state": "WI",
"postal_code": "531881177",
"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": "820 SUMMIT AVE",
"city": "OCONOMOWOC",
"state": "WI",
"postal_code": "530663900",
"telephone_number": "262-567-0223",
"fax_number": "262-567-6380"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PROHEALTH MEDICAL GROUP INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "PROHEALTH MEDICAL GROUP INC",
"enumeration_date": "2008-10-28",
"last_updated": "2022-05-23",
"certification_date": "2022-05-23",
"status": "A",
"authorized_official_last_name": "GEISS",
"authorized_official_first_name": "PETER",
"authorized_official_middle_name": "T",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "262-928-8669",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": "WI",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oconomowoc, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.