Individual provider Active NPI

Wayne Chen, PSY.D.

  • Psychologist
  • Wauwatosa, WI
National Provider Identifier
1710274691
Registry record updated Jun 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
3429-57 Issued in WI
Practice address
10045 W Lisbon Ave
Wauwatosa, WI 53222
Phone
(414) 358-7144
Fax
(414) 358-7158
NPI assigned
Jun 29, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 3429-57 WI Primary

Addresses

Primary practice location

10045 W Lisbon Ave
Wauwatosa, WI 53222

Mailing address

N99W14600 Amber Dr
Germantown, WI 53022-6611
Phone (262) 365-8272

Other identifiers 1

IdentifierTypeStateIssuer
100034875MedicaidWI

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190722000827 WI Practitioner - Clinical Psychologist 2466788948 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3429-57WIMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Alternatives in Psychological Consultation, S.C. CurrentSince May 24, 2019 Accepting new patients

Locations

10045 W Lisbon Ave
Wauwatosa, WI 53222
Phone (414) 358-7144

6737 W Washington St
Ste 1300
West Allis, WI 53214
Phone (414) 358-7144

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1309305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529107200000",
    "number": "1710274691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N99W14600 AMBER DR",
            "city": "GERMANTOWN",
            "state": "WI",
            "postal_code": "530226611",
            "telephone_number": "262-365-8272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10045 W LISBON AVE",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "53222",
            "telephone_number": "414-358-7144",
            "fax_number": "414-358-7158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHEN",
        "first_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-29",
        "last_updated": "2018-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WI",
            "license": "3429-57",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100034875",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wauwatosa, WI

Sources for this page

Verify at the official NPI Registry.