Organization Active NPI

PPM Wisconsin LLC

  • Multi-Specialty Clinic/Center
  • Germantown, WI
National Provider Identifier
1811601776
Registry record updated Jun 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
PPM WISCONSIN LLC
Practice address
W175N11117 Stonewood Dr Ste 100
Germantown, WI 53022-6505
Phone
(888) 253-6598
NPI assigned
Jan 5, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2025

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

Authorized official

Name
Amber L Tueller
Title
Secretary
Phone
(208) 207-2726

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

W175N11117 Stonewood Dr Ste 100
Germantown, WI 53022-6505

Mailing address

W175N11117 Stonewood Dr Ste 100
Germantown, WI 53022-6505
Phone (888) 253-6598

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240308000896 WI Part B Supplier - Clinic/Group Practice 1456797729 Receives reassigned benefits from 3 practitioners
Practice locations: Germantown, WI

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1672876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749168000000",
    "number": "1811601776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W175N11117 STONEWOOD DR STE 100",
            "city": "GERMANTOWN",
            "state": "WI",
            "postal_code": "530226505",
            "telephone_number": "888-253-6598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W175N11117 STONEWOOD DR STE 100",
            "city": "GERMANTOWN",
            "state": "WI",
            "postal_code": "530226505",
            "telephone_number": "888-253-6598"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PPM WISCONSIN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-05",
        "last_updated": "2025-06-06",
        "certification_date": "2025-06-06",
        "status": "A",
        "authorized_official_last_name": "TUELLER",
        "authorized_official_first_name": "AMBER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "208-207-2726"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Germantown, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.