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Prohealth Medical Group Inc

Organization Active NPI Internal Medicine Physician · Delafield, WI

NPI 1962543751 · NPPES record last updated May 24, 2022

Key facts

NPI
1962543751
Entity type
Organization (NPI type 2)
Primary specialty
Internal Medicine Physician 207R00000X
Legal business name
PROHEALTH MEDICAL GROUP INC
Practice address
2750 Golf Road
Delafield, WI 53018-2062
Phone
(262) 928-4900
Fax
(262) 928-4960
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
52D0994378Prohealth Medical Group, Inc -
2750 Golf Rd, Suite C, Delafield, WI 53018		Certificate of waiverMay 25, 2027

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
O20111212000815 WI DME Supplier - Physician - General Practice 3476465188 Practice locations: Delafield, WI

National Provider Directory

Part of
Med Assoc Men Falls LTD

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X
Internal Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207R00000X Yes
Obstetrics & Gynecology Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207V00000X
Pediatrics Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 208000000X

Addresses

Primary practice location

2750 Golf Road
Delafield, WI 53018-2062

Mailing address

N17 W24100 Riverwood Dr
Suite 250
Waukesha, WI 53188-1131
Phone (262) 928-4100

Other identifiers

IdentifierTypeStateIssuer
32899800MedicaidWI
0505180012OtherWIDME

Other providers in Delafield, WI

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

Sources for this page

Verify at the official NPI Registry.