Active NPI
Timothy Raymond Gengembre, PA-C
- Physician Assistant
- Elm Grove, WI
National Provider Identifier
1831354075
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 245-023
- Practice address
- 1650 Pilgrim Pkwy
Elm Grove, WI 53122-1531 - Phone
- (262) 366-8985
- NPI assigned
- Jul 28, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 245-023 | WI | Primary |
Addresses
Primary practice location
1650 Pilgrim Pkwy
Elm Grove, WI 53122-1531
Mailing address
1650 Pilgrim Pkwy
Elm Grove, WI 53122-1531
Phone (262) 366-8985
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 42908600 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 245 | WI | MD | Occupational Therapy Assistant |
| 245-023 | WI | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wauwatosa Pain Management , LLC | Past | Accepting new patients |
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.
-
- Pain Clinic/Center
- Wauwatosa, WI
- NPI 1649511304
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1217203200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1755648000000",
"number": "1831354075",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1650 PILGRIM PKWY",
"city": "ELM GROVE",
"state": "WI",
"postal_code": "531221531",
"telephone_number": "262-366-8985"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1650 PILGRIM PKWY",
"city": "ELM GROVE",
"state": "WI",
"postal_code": "531221531",
"telephone_number": "262-366-8985"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GENGEMBRE",
"first_name": "TIMOTHY",
"middle_name": "RAYMOND",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-07-28",
"last_updated": "2025-08-20",
"certification_date": "2025-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WI",
"license": "245-023",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "42908600",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Elm Grove, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.