Active NPI
Dan Thomas Cleary, MD
- Internal Medicine Physician
- Oconomowoc, WI
National Provider Identifier
1972615136
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 21232
- Practice address
- 1185 Corporate Center Dr
Prohealth Care Medical Associates
Oconomowoc, WI 53066-4887 - Phone
- (262) 928-8400
- Fax
- (262) 928-8484
- NPI assigned
- Aug 31, 2006
- 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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 21232 | WI | Primary |
Addresses
Primary practice location
1185 Corporate Center Dr
Prohealth Care Medical Associates
Oconomowoc, WI 53066-4887
Mailing address
1185 Corporate Center Dr
Prohealth Care Medical Associates
Oconomowoc, WI 53066-4887
Phone (262) 928-8400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30106700 | 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
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21232 | WI | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prohealth Medical Group Inc | Internal Medicine | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1326844800000",
"number": "1972615136",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1185 CORPORATE CENTER DR",
"address_2": "PROHEALTH CARE MEDICAL ASSOCIATES",
"city": "OCONOMOWOC",
"state": "WI",
"postal_code": "530664887",
"telephone_number": "262-928-8400",
"fax_number": "262-928-8484"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1185 CORPORATE CENTER DR",
"address_2": "PROHEALTH CARE MEDICAL ASSOCIATES",
"city": "OCONOMOWOC",
"state": "WI",
"postal_code": "530664887",
"telephone_number": "262-928-8400",
"fax_number": "262-928-8484"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLEARY",
"first_name": "DAN",
"middle_name": "THOMAS",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-31",
"last_updated": "2012-01-18",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "WI",
"license": "21232",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30106700",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oconomowoc, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.