Individual provider Active NPI

Rita Gnyawali, M.D.

  • Pediatrics Physician
  • Milwaukee, WI
National Provider Identifier
1568721959
Registry record updated May 7, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
57103-20 Issued in WI
Practice address
4267 W Fond Du Lac Ave
Milwaukee, WI 53216-3527
Phone
(414) 873-3440
NPI assigned
May 7, 2012
Last updated
May 7, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 7, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 57103-20 WI Primary

Addresses

Primary practice location

4267 W Fond Du Lac Ave
Milwaukee, WI 53216-3527

Mailing address

4267 W Fond Du Lac Ave
Milwaukee, WI 53216-3527
Phone (414) 873-3440

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121126000652 WI Practitioner - Pediatric Medicine 3274784194 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
57103-20WIMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Samir Mullick MD SC Pediatrics CurrentSince Aug 29, 2012 Accepting new patients
Prohealth Medical Group Inc. Pediatrics CurrentSince Jul 1, 2023 Accepting new patients
Prohealth Medical Group Inc Pediatrics Past Accepting new patients

Locations

4267 W Fond du Lac Ave
Milwaukee, WI 53216
Phone (414) 873-3440

240 Maple Ave
Mukwonago, WI 53149
Phone (262) 928-1900

725 American Ave
Waukesha, WI 53188
Phone (262) 544-2011

N17W24100 Riverwood Dr
Waukesha, WI 53188
Phone (262) 820-3093

Interoperability endpoints

  • Direct secure messaging: rgnyawali163924@direct.phci.org

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1336348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1336348800000",
    "number": "1568721959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4267 W FOND DU LAC AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532163527",
            "telephone_number": "414-873-3440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4267 W FOND DU LAC AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532163527",
            "telephone_number": "414-873-3440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GNYAWALI",
        "first_name": "RITA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-07",
        "last_updated": "2012-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WI",
            "license": "57103-20",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.