Individual provider Active NPI

Aaron John Grace, PSY.D.

  • Health Psychologist
  • Waukesha, WI
National Provider Identifier
1720311467
Registry record updated Oct 29, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health PsychologistTaxonomy code 103TH0004X
License
3049-57 Issued in WI
Practice address
210 NW Barstow St
Suite 201
Waukesha, WI 53188-3771
Phone
(262) 548-6903
Fax
(262) 548-3820
NPI assigned
Sep 14, 2009
Last updated
Oct 29, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 3049-57 WI
Health Psychologist 103TH0004X 3049-57 WI Primary

Addresses

Primary practice location

210 NW Barstow St
Suite 201
Waukesha, WI 53188-3771

Mailing address

210 NW Barstow St
Suite 201
Waukesha, WI 53188-3771
Phone (262) 548-6903

Other identifiers 1

IdentifierTypeStateIssuer
1720311467MedicaidWI

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
I20121114000150 WI Practitioner - Clinical Psychologist 4183875453 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2010
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)

210 NW Barstow St
Suite 201
Waukesha, WI 53188-3771
Phone (262) 555-4869

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3049-57WIMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Prohealth Medical Group Inc. CurrentSince Jun 27, 2016 Accepting new patients
Prohealth Medical Group Inc CurrentSince Jun 27, 2016 Accepting new patients
The Medical College of Wisconsin, Inc. CurrentSince Oct 11, 2012 Accepting new patients

Locations

10911 N Port Washington Rd
Mequon, WI 53092
Phone (262) 241-2080

Bin 88350
Milwaukee, WI 53288
Phone (414) 805-3122

210 NW Barstow St
Ste 201
Waukesha, WI 53188
Phone (262) 548-6903

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

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

8701 Watertown Plank Rd
Wauwatosa, WI 53226
Phone (414) 456-4100

Interoperability endpoints

  • Direct secure messaging: agrace44048@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": "1252886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1351468800000",
    "number": "1720311467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 NW BARSTOW ST",
            "address_2": "SUITE 201",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531883771",
            "telephone_number": "262-548-6903",
            "fax_number": "262-548-3820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 NW BARSTOW ST",
            "address_2": "SUITE 201",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531883771",
            "telephone_number": "262-548-6903",
            "fax_number": "262-548-3820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRACE",
        "first_name": "AARON",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-09-14",
        "last_updated": "2012-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "3049-57",
            "primary": false
        },
        {
            "code": "103TH0004X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health",
            "state": "WI",
            "license": "3049-57",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1720311467",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waukesha, WI

Sources for this page

Verify at the official NPI Registry.