Individual provider Active NPI

Peter Haan Johnson, M.D.

  • Hematology & Oncology Physician
  • Waukesha, WI
National Provider Identifier
1407948763
Registry record updated Jan 20, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
L8751 Issued in TX
Practice address
721 American Ave Ste 108
Prohealth Care Regional Cancer Center
Waukesha, WI 53188-5071
Phone
(262) 928-5350
NPI assigned
Sep 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X L8751 TX Primary

Addresses

Primary practice location

721 American Ave Ste 108
Prohealth Care Regional Cancer Center
Waukesha, WI 53188-5071

Mailing address

721 American Ave Ste 108
Prohealth Care Regional Cancer Center
Waukesha, WI 53188-5071
Phone (262) 928-5350

Other identifiers 1

IdentifierTypeStateIssuer
176675001MedicaidTX

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
I20070814000189 WI Practitioner - Hematology/Oncology 0345213963 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hematology/Oncology
Education
University of Kentucky College of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

13111 N Port Washington Rd
Mequon, WI 53097-2416
Phone (262) 243-7300

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Columbia St. Mary's Hospital Milwaukee, Inc CurrentSince Mar 13, 2024 Accepting new patients
Prohealth Medical Group Inc Hematology & Oncology Past Accepting new patients
Columbia St. Mary's Hospital Milwaukee, Inc Past Accepting new patients

Locations

2750 Golf Rd
Delafield, WI 53018
Phone (262) 928-4900

W180N8085 Town Hall Rd
Menomonee Fls, WI 53051
Phone (262) 257-5000

2350 N Lake Dr
Ste 100
Milwaukee, WI 53211
Phone (414) 298-7250

2350 N Lake Dr
Ste G1
Milwaukee, WI 53211
Phone (414) 291-1556

13111 N Port Washington Rd
Thiensville, WI 53097
Phone (262) 243-7300

N14W23900 Stone Ridge Dr
Waukesha, WI 53188
Phone (262) 549-3030

801 S 70th St
West Allis, WI 53214
Phone (414) 773-6600

Organizations & group practices 3

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1327017600000",
    "number": "1407948763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "721 AMERICAN AVE STE 108",
            "address_2": "PROHEALTH CARE REGIONAL CANCER CENTER",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531885071",
            "telephone_number": "262-928-5350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "721 AMERICAN AVE STE 108",
            "address_2": "PROHEALTH CARE REGIONAL CANCER CENTER",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531885071",
            "telephone_number": "262-928-5350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "PETER",
        "middle_name": "HAAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-28",
        "last_updated": "2012-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "TX",
            "license": "L8751",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "176675001",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waukesha, WI

Sources for this page

Verify at the official NPI Registry.