NPIMap

Prohealth Home Care Inc

Organization Active NPI Home Health Agency · Waukesha, WI

NPI 1497720767 · NPPES record last updated Apr 20, 2016

Key facts

NPI
1497720767
Entity type
Organization (NPI type 2)
Primary specialty
Home Health Agency 251E00000X
Legal business name
PROHEALTH HOME CARE INC
Practice address
2000 Pewaukee Rd C
Waukesha, WI 53188
Phone
(262) 928-7444
Fax
(262) 928-7446
NPI assigned
Feb 21, 2006
Organization subpart
No

Authorized official

Name
Mr. Thomas W Johnson
Title
Reimbursement Manager
Phone
(262) 928-4704

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 1

Organizations that report the same tax identification number in the National Provider Directory.

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 95

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 95

Medicare Care Compare: Home health agency

Listed as
Prohealth Home Care CCN 527178
Overall star rating
★★★★☆ 3.5 of 5
Ownership
Non-Profit
Certified
Jan 23, 1986
Medicare certification status
Active (Provider of Services file)
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Source: Medicare Care Compare.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in WI

Home health agency certification: CCN 527178

Legal name
PROHEALTH HOME CARE INC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jan 23, 1986
Last certification
Mar 6, 2019
Ownership / control type
Non-Profit
Organization structure
Corporation · Non-profit
Incorporated
Jun 25, 2003 in WI
Enrollment address
N17W24100 Riverwood Dr
Ste 200
Waukesha, WI 53188-1187
HHA Branch

All disclosed owners & managing parties 6

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Thomas W Johnson
Individual 		W-2 Managing Employee Nov 24, 2015
Prohealth Care Inc
Organization · Waukesha, WI
Corporation, Non-profit 		5% Or Greater Direct Ownership Interest Mar 1, 2012 100%
Susan a Edwards
Individual 		Corporate Officer
Ceo/Board Member		 Mar 28, 2015 100%
Gary Anthony Beyer
Individual 		Corporate Officer
Board Chairman		 Jan 1, 2015
John Scott Hallet
Individual 		Corporate Officer
Board Member		 Jan 1, 2015
Andrew S Gutierrez
Individual 		Corporate Director
Cfo		 Dec 22, 2021
W-2 Managing Employee Dec 22, 2021

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20031014000013 WI Part a Provider - Home Health Agency 5698687531 Practice locations: Waukesha, WI

National Provider Directory

Tax ID family
Angels Grace Hospice (2 organizations share this tax ID)

Locations

N17W24100 Riverwood Dr
Ste 200
Waukesha, WI 53188
Phone (262) 928-7444

2000 Pewaukee Rd
Ste C
Waukesha, WI 53188
Phone (262) 928-7444

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Yes

Addresses

Primary practice location

2000 Pewaukee Rd C
Waukesha, WI 53188

Mailing address

2000 Pewaukee Rd C
Waukesha, WI 53188
Phone (262) 928-7444

Other identifiers

IdentifierTypeStateIssuer
41515100MedicaidWI
6001234OtherWIUNITED HEALTH CARE

Other providers in Waukesha, WI

All providers in Waukesha, WI · Home Health Agency in Wisconsin

Sources for this page

Verify at the official NPI Registry.