Individual provider Active NPI

Michael Patrick Reis, MD

  • Emergency Medicine Physician
  • Wauwatosa, WI
National Provider Identifier
1619437878
Registry record updated Jun 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
76907-20 Issued in WI
Practice address
10625 W North Ave Ste 101B
Wauwatosa, WI 53226-2315
Phone
(414) 877-5350
Fax
(414) 877-5360
NPI assigned
Mar 23, 2019
Last updated
Jun 21, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Emergency Medicine Physician 207P00000X 76907-20 WI Primary

Addresses

Primary practice location

10625 W North Ave Ste 101B
Wauwatosa, WI 53226-2315

Mailing address

10625 W North Ave Ste 101B
Wauwatosa, WI 53226-2315
Phone (414) 877-5350

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
I20220524001949 WI Practitioner - Emergency Medicine 3274867254 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Medical College of Wisconsin, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Emergency Medicine Specialists SCGroup PAC ID 8729975461, 220 clinicians

Practice addresses (Care Compare)

101 Main St
Neenah, WI 54956-2570
Phone (920) 727-4200

1506 S Oneida St
Appleton, WI 54915-1305
Phone (920) 738-2000

1855 S Koeller St
Oshkosh, WI 54902-6186
Phone (920) 223-7000

500 S Oakwood Rd
Oshkosh, WI 54904-7944
Phone (920) 223-2000

5000 W Chambers St
Milwaukee, WI 53210-1650
Phone (414) 447-2000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
76907-20WIMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
EMS Observation, S.C. Emergency Medicine CurrentSince Jun 26, 2022 Accepting new patients

Locations

10101 S 27th St
Franklin, WI 53132
Phone (414) 325-4700

2301 N Lake Dr
Milwaukee, WI 53211
Phone (414) 270-4932

10625 W North Ave
Ste 101B
Wauwatosa, WI 53226
Phone (414) 727-9183

Organizations & group practices 2

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 2

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": "1553299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655769600000",
    "number": "1619437878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10625 W NORTH AVE STE 101B",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532262315",
            "telephone_number": "414-877-5350",
            "fax_number": "414-877-5360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10625 W NORTH AVE STE 101B",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532262315",
            "telephone_number": "414-877-5350",
            "fax_number": "414-877-5360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REIS",
        "first_name": "MICHAEL",
        "middle_name": "PATRICK",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-23",
        "last_updated": "2022-06-21",
        "certification_date": "2022-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WI",
            "license": "76907-20",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wauwatosa, WI

Sources for this page

Verify at the official NPI Registry.