Prisma Wisconsin LLC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

PRISMA WISCONSIN LLC

Practice address

13500 Watertown Plank Rd Ste 102
Elm Grove, WI 53122-2222

Phone

(206) 785-1015

Fax

(206) 785-1023

NPI assigned

Feb 6, 2024

Organization subpart

No

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

Authorized official

Name

Dr. Scott Wiener, MD

Title

Medical Director

Phone

(206) 939-1079

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1707177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707177600000",
    "number": "1497519979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2031 RIDGE END RD",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234541028",
            "telephone_number": "206-939-1079",
            "fax_number": "206-785-1023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13500 WATERTOWN PLANK RD STE 102",
            "city": "ELM GROVE",
            "state": "WI",
            "postal_code": "531222222",
            "telephone_number": "206-785-1015",
            "fax_number": "206-785-1023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRISMA WISCONSIN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-06",
        "last_updated": "2024-02-06",
        "certification_date": "2024-02-06",
        "status": "A",
        "authorized_official_last_name": "WIENER",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "206-939-1079",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "364SP0809X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health, Adult",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jill M Petryczkiewycz, PHYSICAL THERAPIST
• Margaret Ann Pofahl, LCSW
• Julie D Powers, PHYSICAL THERAPY ASS
• Prisma Health PLLC
• Prisma Wellness, PLLC
• Jessica Ramintho, APNP
• Jelanny Ramirez Pavon
• Arthur Dudley Rapkin, O.M.D.
• Lana Rasmuaaen
• Red Oak Counseling, LTD.

• Psychiatry Physician in Elm Grove, WI
• Providers in Elm Grove, WI by specialty
• Psychiatry Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.