Individual provider Active NPI

Andrea L Pollpeter, APNP

  • Nurse Practitioner
  • Mukwonago, WI
National Provider Identifier
1619416518
Registry record updated Oct 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
7536 Issued in WI
Practice address
240 Maple Ave
Mukwonago, WI 53149-8475
Phone
(262) 928-1900
NPI assigned
Feb 13, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 7536 WI Primary

Addresses

Primary practice location

240 Maple Ave
Mukwonago, WI 53149-8475

Mailing address

240 Maple Ave
Mukwonago, WI 53149-8475
Phone (262) 928-1900

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170323000425 WI Practitioner - Nurse Practitioner 7012292659 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
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)

N17W24100 Riverwood Dr
Waukesha, WI 53188-1127
Phone (262) 820-3093

Hospital & facility affiliations

  • Waukesha Memorial Hospital Hospital, Waukesha, WI, CCN 520008
  • Oconomowoc Memorial Hospital Hospital, Oconomowoc, WI, CCN 520062

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Prohealth Medical Group Inc CurrentSince Apr 24, 2017 Accepting new patients
Prohealth Medical Group Inc. CurrentSince Apr 24, 2017 Accepting new patients
Prohealth Medical Group Inc Past Accepting new patients

Locations

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

N57W24950 N Corporate Cir
Sussex, WI 53089
Phone (262) 544-4411

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

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

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 and National Provider Directory roles.

Hospital & facility affiliations 3

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": "1486944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728432000000",
    "number": "1619416518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 MAPLE AVE",
            "city": "MUKWONAGO",
            "state": "WI",
            "postal_code": "531498475",
            "telephone_number": "262-928-1900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 MAPLE AVE",
            "city": "MUKWONAGO",
            "state": "WI",
            "postal_code": "531498475",
            "telephone_number": "262-928-1900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLLPETER",
        "first_name": "ANDREA",
        "middle_name": "L",
        "credential": "APNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-02-13",
        "last_updated": "2024-10-09",
        "certification_date": "2024-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "7536",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mukwonago, WI

Sources for this page

Verify at the official NPI Registry.