Individual provider Active NPI

Sally Lohs, M.D.

  • Child & Adolescent Psychiatry Physician
  • Brookfield, WI
National Provider Identifier
1396139671
Registry record updated Sep 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
License
1396139671 Issued in WI
Practice address
12760 W North Ave BLDG a
Brookfield, WI 53005-4628
Phone
(262) 439-5500
Fax
(866) 439-5221
NPI assigned
Mar 24, 2015
Last updated
Sep 15, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 66315-20 WI
Child & Adolescent Psychiatry Physician 2084P0804X 1396139671 WI Primary
General Practice Physician 208D00000X 66315-20 WI

Addresses

Primary practice location

12760 W North Ave BLDG a
Brookfield, WI 53005-4628

Mailing address

12760 W North Ave BLDG a
Brookfield, WI 53005-4628
Phone (262) 439-5500

Other names 1

  • Sally Martinez Former name

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
I20170309001149 WI Practitioner - PsychiatryPractitioner - General Practice 7012291180 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Medical College of Wisconsin, 2016
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Milwaukee Psychiatric Physicians CharteredGroup PAC ID 0840249751, 5 clinicians

Practice addresses (Care Compare)

12760 W N Ave
Brookfield, WI 53005-4628
Phone (262) 439-5500

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
66315-20WIMDPsychiatry Physician
1396139671WIMDChild & Adolescent Psychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rogers Memorial Hospital Incorporated CurrentSince Jan 1, 2018 Accepting new patients

Locations

34700 Valley Rd
Oconomowoc, WI 53066

11101 W Lincoln Ave
West Allis, WI 53227
Phone (414) 203-4500

2424 S 102nd St
West Allis, WI 53227
Phone (414) 373-7474

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1427155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600128000000",
    "number": "1396139671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12760 W NORTH AVE BLDG A",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530054628",
            "telephone_number": "262-439-5500",
            "fax_number": "866-439-5221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12760 W NORTH AVE BLDG A",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530054628",
            "telephone_number": "262-439-5500",
            "fax_number": "866-439-5221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOHS",
        "first_name": "SALLY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-24",
        "last_updated": "2020-09-15",
        "certification_date": "2020-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WI",
            "license": "66315-20",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "WI",
            "license": "1396139671",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "WI",
            "license": "66315-20",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SALLY",
            "last_name": "MARTINEZ",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Brookfield, WI

Sources for this page

Verify at the official NPI Registry.