Proactive MD Wi SC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

PROACTIVE MD WI SC

Doing business as

Proactive MD Family Health Center

Practice address

20611 Watertown Rd Ste C
Waukesha, WI 53186-1871

Phone

(864) 501-0751

NPI assigned

Sep 9, 2024

Organization subpart

No

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

Authorized official

Name

Mark A Kemble, MD

Title

Chief Medical Officer

Phone

(864) 640-8355

Specialties & licenses 1

Addresses

Other names 1

• Proactive MD Family Health Center Doing business as

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

CLIA laboratory certificates

Tax ID family

Proactive MD4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

• Proactive MD Wi SC

  dba FPS Wellness Center

  • Primary Care Clinic/Center
  • Franklin, WI
  • NPI 1790662484
  NPD tax ID
• Proactive MD Wi SC

  dba Proactive MD Brakebush Westfield Health Center

  • Primary Care Clinic/Center
  • Westfield, WI
  • NPI 1871127092
  NPD tax ID
• Proactive MD Wi SC

  • Primary Care Clinic/Center
  • Greenville, SC
  • NPI 1619615655
  NPD tax ID

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

{
    "created_epoch": "1725840000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788307200000",
    "number": "1932935962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "86 VILLA RD STE 100",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296153052",
            "telephone_number": "864-640-8355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20611 WATERTOWN RD STE C",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531861871",
            "telephone_number": "864-501-0751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROACTIVE MD WI SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-09",
        "last_updated": "2026-09-02",
        "certification_date": "2026-09-02",
        "status": "A",
        "authorized_official_last_name": "KEMBLE",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "864-640-8355",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Proactive MD Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Prestige Therapy and Wellness LLC
• Elizabeth Ann Primasing, RN, MS
• Darryl M. Prince, M.D.
• Alyssa K Printz, LPC
• Private Healthcare Facilities
• Prodesse, Inc.
• Professional Clinical Laboratory, LLC
• Professional Recovery Network
• Prohealth Aligned LLC (ProHealth Care Moreland Surgery Center)
• Prohealth Care Inc

• Primary Care Clinic/Center in Waukesha, WI
• Providers in Waukesha, WI by specialty
• Primary Care Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.