Individual provider Active NPI

Marcus T Perry, MD

  • Internal Medicine Physician
  • Milwaukee, WI
National Provider Identifier
1619056264
Registry record updated Jun 11, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
47343 Issued in WI
Practice address
2311 N Prospect
Milwaukee, WI 53211
Phone
(414) 319-3000
NPI assigned
Nov 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 47343 WI Primary

Addresses

Primary practice location

2311 N Prospect
Milwaukee, WI 53211

Mailing address

4425 N Port Washington Rd
Attn: Csmcp Clinic Credentialing
Glendale, WI 53212-1082
Phone (414) 319-3000

Other identifiers 1

IdentifierTypeStateIssuer
34579800MedicaidWV

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
I20041022000327 WI Practitioner - Internal Medicine 8426019464 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Wisconsin School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Prohealth Medical Group IncGroup PAC ID 3476465188, 475 clinicians

Practice addresses (Care Compare)

2130 Big Bend Rd
Waukesha, WI 53189-7624
Phone (262) 928-7555

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
47343WIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Columbia St. Mary'S Hospital Milwaukee, Inc CurrentSince Oct 31, 2004 Accepting new patients
Prohealth Medical Group Inc. Internal Medicine CurrentSince Aug 1, 2022 Accepting new patients
Columbia St. Mary'S Hospital Milwaukee Inc CurrentSince Oct 31, 2004 Accepting new patients
Internal Medicine Associates, LLC Internal Medicine Past Accepting new patients
Prohealth Medical Group Inc Internal Medicine Past Accepting new patients

Locations

2323 N Lake Dr
Milwaukee, WI 53211
Phone (414) 291-1000

2311 N Prospect Ave
Milwaukee, WI 53211
Phone (414) 319-3000

2130 Big Bend Rd
Waukesha, WI 53189
Phone (262) 928-7555

N14W23900 Stone Ridge Dr
Waukesha, WI 53188
Phone (262) 549-3030

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

801 S 70th St
West Allis, WI 53214
Phone (414) 773-6600

Organizations & group practices 5

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

Hospital & facility affiliations 4

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": "1162512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339372800000",
    "number": "1619056264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4425 N PORT WASHINGTON RD",
            "address_2": "ATTN: CSMCP CLINIC CREDENTIALING",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532121082",
            "telephone_number": "414-319-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2311 N PROSPECT",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "53211",
            "telephone_number": "414-319-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERRY",
        "first_name": "MARCUS",
        "middle_name": "T",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-03",
        "last_updated": "2012-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "47343",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34579800",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.