NPIMap

Organization Active NPI

Wisconsin Wellness MH, LLC

Doing business as Wisconsin Wellness

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Appleton, WI
National Provider Identifier
1548041924
Registry record updated Apr 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
WISCONSIN WELLNESS MH, LLC
Doing business as
Wisconsin Wellness
Practice address
5643 W Waterford LN
Appleton, WI 54913-8438
Phone
(920) 404-2100
NPI assigned
Oct 11, 2023
Last updated
Apr 26, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2024

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

Authorized official

Name
Ryan Joseph Rohde
Title
Executive Director
Phone
(715) 281-0612

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

5643 W Waterford LN
Appleton, WI 54913-8438

Mailing address

5643 W Waterford LN
Appleton, WI 54913-8438
Phone (920) 404-2100

Other names 1

  • Wisconsin Wellness Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250826001667 WI Part B Supplier - Clinic/Group Practice 7719487420 Receives reassigned benefits from 8 practitioners
Practice locations: Grand Chute, WI

National Provider Directory

National Provider Directory

Locations

5643 W Waterford Ln
Grand Chute, WI 54913
Phone (920) 404-2100

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1696982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714089600000",
    "number": "1548041924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5643 W WATERFORD LN",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549138438",
            "telephone_number": "920-404-2100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5643 W WATERFORD LN",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549138438",
            "telephone_number": "920-404-2100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISCONSIN WELLNESS MH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-11",
        "last_updated": "2024-04-26",
        "certification_date": "2024-04-26",
        "status": "A",
        "authorized_official_last_name": "ROHDE",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "715-281-0612"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wisconsin Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Appleton, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2024; 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.