NPIMap

Individual provider Active NPI

Jennifer Lynn Reed, MD

  • Family Medicine Physician
  • Waukesha, WI
National Provider Identifier
1558461129
Registry record updated Jan 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
49088020 Issued in WI
Practice address
2130 Big Bend Rd
Prohealth Care Medical Associates
Waukesha, WI 53189
Phone
(262) 513-7555
Fax
(262) 928-7575
NPI assigned
Sep 24, 2006
Last updated
Jan 9, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 49088020 WI Primary

Addresses

Primary practice location

2130 Big Bend Rd
Prohealth Care Medical Associates
Waukesha, WI 53189

Mailing address

2130 Big Bend Rd
Prohealth Care Medical Associates
Waukesha, WI 53189
Phone (262) 928-7555

Other identifiers 1

IdentifierTypeStateIssuer
34902700MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150716001441 WI Order and Referring Only - Family PracticePractitioner - Family Practice 9032200969

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Medical College of Wisconsin, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advantage Physical Therapy and Sports Rehab, LLCGroup PAC ID 8022016336, shared by 3 NPIs, 289 clinicians

Practice addresses (Care Compare)

3503 E Layton Ave
Unit 100
Cudahy, WI 53110-1408
Phone (414) 489-0270

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
49088020WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prohealth Medical Group Inc Family Medicine Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1159056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326067200000",
    "number": "1558461129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2130 BIG BEND RD",
            "address_2": "PROHEALTH CARE MEDICAL ASSOCIATES",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "53189",
            "telephone_number": "262-928-7555",
            "fax_number": "262-928-7575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2130 BIG BEND RD",
            "address_2": "PROHEALTH CARE MEDICAL ASSOCIATES",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "53189",
            "telephone_number": "262-513-7555",
            "fax_number": "262-928-7575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REED",
        "first_name": "JENNIFER",
        "middle_name": "LYNN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-24",
        "last_updated": "2012-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "49088020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34902700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waukesha, WI

Sources for this page

Verify at the official NPI Registry.