NPIMap

Organization Active NPI

Prohealth Home Care Inc

  • Home Health Agency
  • Waukesha, WI
National Provider Identifier
1497720767
Registry record updated Apr 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 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
Last updated
Apr 20, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2016

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

2000 Pewaukee Rd C
Waukesha, WI 53188

Mailing address

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

Medicare participation

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

Enrollment records 1

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1497720767. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Jun 25, 2003 in WI
Enrollment address
N17W24100 Riverwood Dr
Ste 200
Waukesha, WI 53188-1187
HHA Branch

Other NPIs with the same Medicare PAC ID 1

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

Care Compare: Home health agency

Medicare Care Compare
Listed as
Prohealth Home CareCCN 527178 · All quality measures
Overall star rating
3.5 of 5
Ownership
Non-Profit
Certified
Jan 23, 1986
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory
Tax ID family
Angels Grace Hospice2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

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

Ownership & related parties

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 OfficerCeo/Board Member Mar 28, 2015 100%
Gary Anthony Beyer Individual Corporate OfficerBoard Chairman Jan 1, 2015
John Scott Hallet Individual Corporate OfficerBoard Member Jan 1, 2015
Andrew S Gutierrez Individual Corporate DirectorCfo Dec 22, 2021
W-2 Managing Employee Dec 22, 2021

Owners & managing parties with NPI records 1

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

Facilities with the same owner 3

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

Practitioners & affiliated clinicians

Practitioners 2

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.

Affiliated clinicians 95

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

View all 95

NPI Registry JSON

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

{
    "created_epoch": "1140480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461110400000",
    "number": "1497720767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 PEWAUKEE RD C",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "53188",
            "telephone_number": "262-928-7444",
            "fax_number": "262-928-7446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 PEWAUKEE RD C",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "53188",
            "telephone_number": "262-928-7444",
            "fax_number": "262-928-7446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROHEALTH HOME CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-21",
        "last_updated": "2016-04-20",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "REIMBURSEMENT MANAGER",
        "authorized_official_telephone_number": "262-928-4704",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waukesha, WI

Sources for this page

Verify at the official NPI Registry.