NPIMap

Organization Active NPI

Trillium Care Group LLC

  • Psychologist
  • Elm Grove, WI
National Provider Identifier
1477629640
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
2564 Issued in WI
Legal business name
TRILLIUM CARE GROUP LLC
Practice address
500 Elm Grove Rd
Suite 100
Elm Grove, WI 53122
Phone
(262) 782-2090
Fax
(262) 782-2092
NPI assigned
Nov 28, 2006
Last updated
Sep 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
Teresa C Ortiz, LCSW
Title
Clinical Director Psychotherapist
Phone
(262) 782-2090

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 2564 WI Primary
Clinical Social Worker 1041C0700X 2564 WI

Addresses

Primary practice location

500 Elm Grove Rd
Suite 100
Elm Grove, WI 53122

Mailing address

500 Elm Grove Rd
Suite 100
Elm Grove, WI 53122
Phone (262) 782-2090

Other identifiers 1

IdentifierTypeStateIssuer
42238700MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041223000193 WI Part B Supplier - Clinic/Group Practice 7618935529 Receives reassigned benefits from 5 practitioners
Practice locations: West Allis, WI

National Provider Directory

National Provider Directory

Locations

500 Elm Grove Rd
Ste 100
Elm Grove, WI 53122
Phone (262) 782-2090

4811 S 76th St
#309
Greenfield, WI 53220
Phone (414) 817-0817

10150 W National Ave
Ste 370
West Allis, WI 53227
Phone (262) 782-2090

2363 S 102nd St
Ste 301
West Allis, WI 53227
Phone (262) 782-2090

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1477629640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 ELM GROVE RD",
            "address_2": "SUITE 100",
            "city": "ELM GROVE",
            "state": "WI",
            "postal_code": "53122",
            "telephone_number": "262-782-2090",
            "fax_number": "262-782-2092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 ELM GROVE RD",
            "address_2": "SUITE 100",
            "city": "ELM GROVE",
            "state": "WI",
            "postal_code": "53122",
            "telephone_number": "262-782-2090",
            "fax_number": "262-782-2092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRILLIUM CARE GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "ORTIZ",
        "authorized_official_first_name": "TERESA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR PSYCHOTHERAPIST",
        "authorized_official_telephone_number": "262-782-2090",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WI",
            "license": "2564",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "2564",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42238700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elm Grove, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.

Verify at the official NPI Registry.