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Prohealth Medical Group Inc

Organization Active NPI Internal Medicine Physician · Oconomowoc, WI

NPI 1922149707 · NPPES record last updated May 24, 2022

Key facts

NPI
1922149707
Entity type
Organization (NPI type 2)
Primary specialty
Internal Medicine Physician 207R00000X
Legal business name
PROHEALTH MEDICAL GROUP INC
Practice address
1185 Corporate Center Dr
Oconomowoc, WI 53066-4845
Phone
(262) 928-8400
Fax
(262) 928-8484
NPI assigned
Feb 12, 2007
Organization subpart
Yes
Parent organization (as reported)
PROHEALTH MEDICAL GROUP INC

Authorized official

Name
Peter Geiss, MD
Title
President
Phone
(262) 928-8669

Other NPIs with the same Medicare PAC ID 11

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 12

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 475

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

View all 475

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
52D0890378Prohealth Medical Group, Inc - Oconomowoc
1185 Corporate Center Dr, Suite 175, Oconomowoc, WI 53066		Provider-performed microscopyAug 16, 2026
52D2005007Prohealth Medical Group, Inc -
1185 Corporate Center Drive, Suite 150, Oconomowoc, WI 53066		Certificate of waiverSep 20, 2026
52D2192613Prohealth Medical Group, Inc -
1185 Corporate Center Drive, Oconomowoc, WI 53066		Certificate of waiverSep 10, 2026

Medicare participation

Medicare fee-for-service enrollment
Enrolled in WI

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20111209000152 WI DME Supplier - Physician - General Surgery 3476465188 Practice locations: Oconomowoc, WI

National Provider Directory

Tax ID family
Med Assoc Men Falls LTD (13 organizations share this tax ID)
Part of
Med Assoc Men Falls LTD

Locations

1185 Corporate Center Dr
Ste 240
Oconomowoc, WI 53066
Phone (262) 928-6236

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207N00000X
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X
Internal Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207R00000X Yes
Cardiovascular Disease Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207RC0000X
Pediatrics Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 208000000X

Addresses

Primary practice location

1185 Corporate Center Dr
Oconomowoc, WI 53066-4845

Mailing address

N17W24100 Riverwood Dr
Suite 250
Waukesha, WI 53188-1177
Phone (262) 928-4100

Other identifiers

IdentifierTypeStateIssuer
32869500MedicaidWI
0505180007OtherWIDME

Other providers in Oconomowoc, WI

All providers in Oconomowoc, WI · Internal Medicine Physician in Wisconsin

Sources for this page

Verify at the official NPI Registry.