NPIMap

Prohealth Medical Group Inc

Organization Active NPI Family Medicine Physician · New Berlin, WI

NPI 1962543728 · NPPES record last updated May 24, 2022

Key facts

NPI
1962543728
Entity type
Organization (NPI type 2)
Primary specialty
Family Medicine Physician 207Q00000X
Legal business name
PROHEALTH MEDICAL GROUP INC
Practice address
13900 W National Ave
New Berlin, WI 53151-9515
Phone
(262) 928-4500
Fax
(262) 928-4550
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 on the same Medicare enrollment 14

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Other NPIs with the same Medicare PAC ID 11

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

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
52D0389605Prohealth Medical Group, Inc - New Berlin
13900 W National Ave Ste 100, New Berlin, WI 53151		Provider-performed microscopyApr 22, 2028

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in WI

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20031103000066 WI Part B Supplier - Clinic/Group Practice 3476465188 Receives reassigned benefits from 570 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
O20111208000152 WI DME Supplier - Physician - General Surgery 3476465188 Practice locations: New Berlin, WI

National Provider Directory

Part of
Med Assoc Men Falls LTD

Locations

13900 W National Ave
New Berlin, WI 53151
Phone (262) 928-4500

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207N00000X
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X Yes

Addresses

Primary practice location

13900 W National Ave
New Berlin, WI 53151-9515

Mailing address

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

Other identifiers

IdentifierTypeStateIssuer
32830500MedicaidWI
0505180006OtherWIDME

Other providers in New Berlin, WI

All providers in New Berlin, WI · Family Medicine Physician in Wisconsin

Sources for this page

Verify at the official NPI Registry.